Arzu Ufuk, Atasoy İsmail Tarık, Kızılkurt Taha, Pata Demir Can, Erdil Mehmet, Polat Gökhan
Department of Orthopedics and Traumatology, Marmara University Pendik Research and Training Hospital, Istanbul, Turkey.
Department of Orthopedics and Traumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
Arch Orthop Trauma Surg. 2025 Sep 5;145(1):436. doi: 10.1007/s00402-025-06056-8.
Tunnel widening following anterior cruciate ligament (ACL) reconstruction remains a significant clinical concern. Polyether ether ketone (PEEK) screws offer favorable biomechanical properties and MRI compatibility; however, they lack osteoconductivity, which may contribute to tunnel widening. This study investigated whether hydroxyapatite (HA)-coated polyether ether ketone (PEEK) screws reduce tibial tunnel widening compared to uncoated PEEK screws, considering the osteoconductive properties of HA. We hypothesized that HA-coated PEEK screws would demonstrate significantly less tibial tunnel widening at one year postoperatively than uncoated PEEK screws.
A retrospective cohort study was conducted on patients who underwent primary ACL reconstruction using hamstring autografts. The patients were divided into two groups: Group 1 received HA-coated PEEK interference screws, and Group 2 received uncoated PEEK screws. Tibial tunnel diameters were measured on standardized anteroposterior and lateral radiographs immediately postoperatively (baseline) and at the first-year follow-up. Tunnel width was assessed perpendicular to the tunnel axis at consistent locations, and the percentage tunnel widening was calculated from the baseline. Two independent observers measured the tunnel dimensions separately.
A total of 65 patients were analyzed, of whom 31 received HA-coated PEEK screws and 34 received standard uncoated PEEK screws. At the first-year follow-up, tunnel widening was significantly lower in the HA-coated group across all measurement sites. In the AP view, the proximal, middle, and distal regions showed significantly reduced tunnel widening in the HA-coated group (p < 0.05). A similar outcome was observed in all three regions of the lateral view, with significantly less widening with HA-coated screws than with uncoated screws (p < 0.05).
Compared with standard uncoated PEEK screws, HA-coated PEEK screws significantly reduced tibial tunnel widening at the one-year follow-up after primary ACL reconstruction. The added osteoconductive properties of HA may be the underlying mechanism. These findings suggest that HA-coated screws may offer improved biological fixation and better long-term graft stability compared to uncoated screws.
Level III, retrospective cohort study.
前交叉韧带（ACL）重建术后隧道增宽仍是一个重大的临床问题。聚醚醚酮（PEEK）螺钉具有良好的生物力学性能和MRI兼容性；然而，它们缺乏骨传导性，这可能导致隧道增宽。本研究考虑到羟基磷灰石（HA）的骨传导特性，探讨了HA涂层聚醚醚酮（PEEK）螺钉与未涂层PEEK螺钉相比是否能减少胫骨隧道增宽。我们假设，HA涂层PEEK螺钉在术后一年时胫骨隧道增宽程度将显著低于未涂层PEEK螺钉。
对接受自体腘绳肌腱移植进行初次ACL重建的患者进行了一项回顾性队列研究。患者分为两组：第1组接受HA涂层PEEK干涉螺钉，第2组接受未涂层PEEK螺钉。在术后即刻（基线）和第一年随访时，在标准化的前后位和侧位X线片上测量胫骨隧道直径。在一致的位置垂直于隧道轴评估隧道宽度，并根据基线计算隧道增宽百分比。两名独立观察者分别测量隧道尺寸。
共分析了65例患者，其中31例接受HA涂层PEEK螺钉，34例接受标准未涂层PEEK螺钉。在第一年随访时，HA涂层组所有测量部位的隧道增宽均显著更低。在前后位视图中，HA涂层组近端、中部和远端区域的隧道增宽显著减少（p < 0.05）。在侧位视图的所有三个区域也观察到类似结果，HA涂层螺钉的增宽显著少于未涂层螺钉（p < 0.05）。
与标准未涂层PEEK螺钉相比，HA涂层PEEK螺钉在初次ACL重建术后一年随访时显著减少了胫骨隧道增宽。HA的额外骨传导特性可能是其潜在机制。这些发现表明，与未涂层螺钉相比，HA涂层螺钉可能提供更好的生物固定和更好的长期移植物稳定性。
III级，回顾性队列研究。
