The unpredictable material properties of bioabsorbable PLC interference screws and their adverse effects in ACL reconstruction surgery |
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Authors: | Sujith Konan Fares Sami Haddad |
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Institution: | (1) University College Hospital, London, WC1E 5DB, UK |
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Abstract: | The aim of this study was to look at the clinical outcome of polylactide carbonate (PLC) interference screws in knee ligament
reconstruction surgery. We prospectively followed up 59 patients who underwent primary hamstring anterior cruciate ligament
(ACL) reconstructions using PLC (Calaxo screw; Smith and Nephew, Andover, MA) screws to secure the graft in the tibial tunnel.
The average age was 34 years (range 17–55 years, SD 8.93). Twenty-three (39%) patients presented with complications synovitis
in 15% (nine) patients, prominent tibial swelling in 34% (20) patients and both in seven patients]. In comparison, similar
complications were not seen in two groups of 59 age and sex matched patients in whom PLLA (Bio RCI; Smith and Nephew, Andover,
MA) screws or Titanium (RCI; Smith and Nephew, Andover, MA) screws were used by the same surgeon. The problems encountered
in the PLC screw group did not adversely affect knee stability. Six patients underwent exploration of the tibial tunnel site.
A sterile white cheesy substance was removed, leaving an empty tibial tunnel. The ACL graft was found to be well attached
to tibial tunnel in all cases. The PLC screw diameter, surface area or tibial tunnel diameter did not have any correlation
to the occurrence of complications. Two patients required multiple washouts, one of whom developed a deep infection. The degradation
of PLC screws does not follow the gradual and controlled pattern demonstrated in the ovine model. The unpredictable screw
degradation, and the reaction to it can lead to serious clinical consequences. |
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Keywords: | ACL reconstruction Bioabsorbable screws Ligament reconstruction Adverse effects of implants |
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