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Reduced bone tunnel enlargement post hamstring ACL reconstruction with poly-L-lactic acid/hydroxyapatite
James Robinson1, Chris Huber, Paul Jaraj
1Centre de Chirurgie Orthopédique et Sportive, Clinique de Bordeaux-Mérignac, 9 rue Jean Moulin, 33700 Mérignac, France.
The Knee
|December 15, 2005
Summary
Poly-L-lactic acid/hydroxyapatite blend screws significantly reduced tibial tunnel widening after anterior cruciate ligament (ACL) reconstruction compared to plain PLLA screws. This finding suggests improved screw incorporation and less bone tunnel enlargement in ACL revision surgery.
Area of Science:
- Orthopedic surgery
- Biomaterials science
- Radiology
Background:
- Bone tunnel enlargement after anterior cruciate ligament (ACL) reconstruction poses challenges for revision surgery.
- Bioabsorbable interference screws are commonly used for tibial fixation in ACL reconstruction.
Purpose of the Study:
- To compare postoperative tibial tunnel widening between poly-L-lactic acid/hydroxyapatite blend (PLLA+HA) and plain poly-L-lactic acid (PLLA) bioabsorbable interference screws for tibial fixation in ACL reconstruction.
Main Methods:
- Retrospective comparison of 34 patients undergoing arthroscopically assisted, single-incision, four-strand hamstring ACL reconstruction.
- Spiral CT scans assessed maximum tibial tunnel cross-sectional area at an average follow-up of 28.7 months.
- Evaluation of tunnel wall sclerosis (cortication) adjacent to the interference screw.
Main Results:
- Mean tibial tunnel enlargement was 29.9% with PLLA+HA screws versus 46% with plain PLLA screws (p=0.03).
- Tunnel wall cortication was observed in 21% of patients with PLLA+HA screws compared to 73% with plain PLLA screws (p=0.02).
Conclusions:
- Blending hydroxyapatite with poly-L-lactic acid appears to reduce postoperative tibial tunnel widening following ACL reconstruction.
- Reduced tunnel wall sclerosis with PLLA+HA screws may indicate improved screw incorporation and bone healing.