Bioabsorbable Versus Titanium Screws in Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft: A...

Area of Science:

• Orthopedic surgery
• Biomaterials science
• Medical imaging

Background:

• Bioabsorbable screws, like poly-L-lactic acid with hydroxyapatite (PLLA-HA), offer theoretical imaging and surgical benefits for anterior cruciate ligament reconstruction (ACLR).
• Previous comparisons between PLLA-HA and titanium screws have had limited long-term follow-up.

Purpose of the Study:

• To compare the long-term clinical outcomes of hamstring autograft ACLR using PLLA-HA screws versus titanium screws at 13 years.
• To evaluate differences in clinical scores, tunnel widening, and PLLA-HA screw resorption and ossification over time.

Main Methods:

• A randomized controlled trial (Level 1 evidence) involving 40 patients undergoing ACLR.
• Patients received either PLLA-HA or titanium screws for hamstring autograft fixation.
• Clinical outcomes and tunnel dimensions were assessed at 2, 5, and 13 years using validated scores and imaging (MRI/CT).

Main Results:

• No significant differences in clinical outcomes (IKDC, Lysholm, KT-1000) were observed between the PLLA-HA and titanium groups at any follow-up point (2, 5, or 13 years).
• At 13 years, tibial tunnel volumes were significantly smaller in the PLLA-HA group (2.17 cm³) compared to the titanium group (3.33 cm³).
• PLLA-HA screws demonstrated complete or near-complete resorption by the 13-year follow-up.

Conclusions:

• PLLA-HA and titanium screws provide equivalent long-term clinical results for ACLR with hamstring autografts.
• Despite complete resorption, PLLA-HA screws do not lead to increased tunnel widening and show minimal ossification.
• PLLA-HA screws are a viable option for ACLR fixation, offering comparable clinical efficacy to titanium screws with bioabsorbable advantages.