Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey.
Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey.
Orthop Traumatol Surg Res. 2022 May;108(3):103247. doi: 10.1016/j.otsr.2022.103247. Epub 2022 Feb 12.
Ligament reconstruction is still the main treatment modality for patients with a complete ligament rupture. The semitendinosus tendon, alone quadrupled or double folded and combined with the gracilis tendon, is still the most frequently used autologous graft for a reconstructive procedure. Absorbable interference screw usage has gained popularity in the past decade because they create less artifacts during MR imaging and tend to osteointegrate over the years, arguably leading to a more anatomic fixation. The purpose of this study was to compare the 5-year radiological and clinical results of two different tibial graft fixation screws.
We hypothesized that bioabsorbable interference screws made of bioactive glass would lead to higher rates of osteointegration, better overall clinical results, less foreign body reaction rates and less tibial tunnel widening when compared to the poly-L-lactic acid/hydroxyapatite (PLLA-HA) screws.
Fifty-one patients treated with an anatomic single bundle ACL reconstruction between June 2015 and July 2016 at our institution were included in the study. The tibial graft was fixed with a bioactive glass screw in 24, and with a PLLA-HA in 27 patients. Tibial tunnel widening, foreign body reaction, osteointegration and resorption rates were evaluated and compared on a magnetic resonance scan at a minimum of 5 year postoperatively. Overall clinical results and side-to-side difference on KT-1000 were also analyzed in-between groups.
Tibial tunnel widening was similar for both groups. Foreign body reaction, while not statistically significant, was less aggressive when bioactive glass screws were used. Osteointegration and resorption rates of the bioactive glass screws were significantly higher than the PLLA-HA group (p=0.000). While all patients showed an overall improvement on postoperative scores (p=0.000), patients with a bioactive glass interference screw had statistically higher translational stability with KT-1000, compared to the poly-L-lactic acid/hydroxyapatite group (p=0.001).
At a minimum of 5 years, compared to conventional PLLA-HA interference screws, 45S5 bioactive glass screw provide higher resorption rates, are more highly biodegradable and provide overall good clinical results.
III.
韧带重建仍然是治疗完全韧带断裂患者的主要治疗方式。半腱肌腱单独四股或双股折叠，并与股薄肌腱结合，仍然是最常用的自体移植物进行重建手术。在过去十年中，可吸收的干扰螺钉的使用变得越来越流行，因为它们在磁共振成像（MRI）中产生的伪影较少，并且随着时间的推移往往会骨整合，可以认为它们可以实现更符合解剖学的固定。本研究的目的是比较两种不同胫骨移植物固定螺钉的 5 年影像学和临床结果。
我们假设生物活性玻璃制成的可吸收的干扰螺钉会导致更高的骨整合率，更好的整体临床结果，更低的异物反应率和更少的胫骨隧道增宽，与聚-L-乳酸/羟基磷灰石（PLLA-HA）螺钉相比。
本研究共纳入 2015 年 6 月至 2016 年 7 月在我院接受解剖学单束 ACL 重建的 51 例患者。胫骨移植物用生物活性玻璃螺钉固定 24 例，用 PLLA-HA 固定 27 例。术后至少 5 年时，通过 MRI 扫描评估和比较胫骨隧道增宽、异物反应、骨整合和吸收率，并对两组之间的整体临床结果和 KT-1000 的侧到侧差异进行分析。
两组胫骨隧道增宽相似。异物反应虽然没有统计学意义，但使用生物活性玻璃螺钉时反应较轻。生物活性玻璃螺钉的骨整合和吸收率明显高于 PLLA-HA 组（p=0.000）。虽然所有患者术后评分均有整体改善（p=0.000），但与 PLLA-HA 组相比，使用生物活性玻璃干扰螺钉的患者 KT-1000 的平移稳定性具有统计学意义（p=0.001）。
至少 5 年，与传统的 PLLA-HA 干扰螺钉相比，45S5 生物活性玻璃螺钉提供更高的吸收率，更具生物降解性，提供整体良好的临床结果。
III 级。
