Scrivens Brian, Kluczynski Melissa A, Fineberg Marc S, Bisson Leslie J
Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, The State University of New York at Buffalo, Buffalo, New York, USA.
Orthop J Sports Med. 2021 May 6;9(5):23259671211006477. doi: 10.1177/23259671211006477. eCollection 2021 May.
Bioabsorbable interference screws tend to have high resorption rates after anterior cruciate ligament (ACL) reconstruction; however, no studies have examined screws composed of 30% biphasic calcium phosphate and 70% poly-d-lactide (30% BCP/70% PLDLA).
To evaluate femoral and tibial tunnel widening and resorption of 30% BCP/70% PLDLA interference screws and replacement with bone at 2 to 5 years after ACL reconstruction using bone-patellar tendon-bone (BTB) autograft.
Case series; Level of evidence, 4.
Included were 20 patients who had undergone ACL reconstruction using BTB autograft and were reevaluated 2 to 5 years after surgery using computed tomography scans. Tunnel measurements were obtained from computed tomography scans in the sagittal and coronal planes and were compared with known tunnel measurements based on operative reports. These images and measurements were used to assess tunnel widening, resorption of the 30% BCP/70% PLDLA screw, its replacement with bone, and possible cyst formation. Paired tests were used to compare initial and final femoral and tibial tunnel measurements.
The cross-sectional area of the femoral tunnel decreased at the aperture ( = .03), middle ( = .0002), and exit ( < .0001) of the tunnel compared with the initial femoral tunnel size, and the tibial tunnel cross-sectional area decreased at the aperture ( < .0001) and exit ( = .01) of the tunnel compared with the initial tibial tunnel size. Bone formation was observed in 100% of femoral tunnels and 94.7% of tibial tunnels. Screw resorption was 100% in the femur and 94.7% in the tibia at the final follow-up. Cysts were noted around the femoral tunnel in 2 patients (5.1%).
The 30% BCP/70% PLDLA interference screws used for ACL reconstruction using BTB autograft had high rates of resorption and replacement with bone, and there were no increases in tunnel size at 2 to 5 years postoperatively. The authors observed a low rate of cyst formation and no other adverse events stemming from the use of this specific biointerference screw, suggesting that this type of screw is a reasonable option for graft fixation with minimal unfavorable events and a reliable resorption profile.
在进行前交叉韧带（ACL）重建后，生物可吸收挤压螺钉往往具有较高的吸收率；然而，尚无研究对由30%双相磷酸钙和70%聚-d-乳酸（30%BCP/70%PLDLA）组成的螺钉进行过研究。
评估采用骨-髌腱-骨（BTB）自体移植物进行ACL重建后2至5年，30%BCP/70%PLDLA挤压螺钉在股骨和胫骨隧道中的增宽和吸收情况以及被骨替代的情况。
病例系列；证据等级，4级。
纳入20例采用BTB自体移植物进行ACL重建的患者，术后2至5年使用计算机断层扫描进行复查。通过计算机断层扫描在矢状面和冠状面获取隧道测量数据，并与基于手术报告的已知隧道测量数据进行比较。这些图像和测量数据用于评估隧道增宽、30%BCP/70%PLDLA螺钉的吸收、其被骨替代的情况以及可能的囊肿形成。采用配对检验比较初始和最终的股骨和胫骨隧道测量数据。
与初始股骨隧道尺寸相比，股骨隧道在开口处（P = 0.03）、中部（P = 0.0002）和出口处（P < 0.0001）的横截面积减小；与初始胫骨隧道尺寸相比，胫骨隧道在开口处（P < 0.0001）和出口处（P = 0.01）的横截面积减小。在100%的股骨隧道和94.7%的胫骨隧道中观察到骨形成。在最后一次随访时，股骨中螺钉吸收率为100%，胫骨中为94.7%。2例患者（5.1%）在股骨隧道周围发现囊肿。
采用BTB自体移植物进行ACL重建时使用的30%BCP/70%PLDLA挤压螺钉具有较高的吸收率和被骨替代率，术后2至5年隧道尺寸未增加。作者观察到囊肿形成率较低，且使用这种特定的生物挤压螺钉未出现其他不良事件，这表明这种类型的螺钉是移植物固定的合理选择，不良事件最少且吸收情况可靠。
