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Is a Resorbable Citrate-based Bioceramic Device Associated With Osseous Integration? An Early Retrospective MRI

Wayne S Berberian¹, Jonathan Day², Lew Schon²

¹Hackensack Meridian School of Medicine, Nutley, NJ, USA.

Clinical Orthopaedics and Related Research

|June 15, 2026

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This study found no bone tunnel enlargement or complications with citrate-based bioceramic devices after 2 years. The resorbable implants showed good bone integration, suggesting a promising alternative to traditional fixation methods.

Area of Science:

Orthopaedic Surgery
Biomaterials Science
Medical Imaging

Background:

Bioresorbable fixation devices offer advantages over traditional implants, but concerns exist regarding osteolysis and bone tunnel enlargement with current polymer-based options.
Citrate-based bioceramic devices (Citregen®) represent a novel resorbable material for orthopaedic applications, with limited data on their long-term performance and imaging characteristics.
Existing bioresorbable devices made from lactic and glycolic acid polymers are associated with implant-related osteolysis, inflammation, and inconsistent bone integration.

Purpose of the Study:

To evaluate bone tunnel enlargement on MRI at ≥2 years post-implantation of citrate-based bioceramic devices.
To assess for adverse findings like bone marrow edema or device breakage on MRI at ≥2 years.
To determine the degree of bone integration with these devices on MRI at ≥2 years.

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To document early clinical complications following soft tissue fixation with these devices.

Main Methods:

Retrospective review of MRI scans (≥2 years post-op) from 13 patients (25 devices) who received citrate-based bioceramic interference devices for foot and ankle procedures.
Quantification of bone tunnel enlargement by measuring the gap between the bone tunnel and device threads.
Assessment of bone marrow edema and osseous integration using standardized scales with high interrater reliability.
Retrospective chart analysis for clinical complications.

Main Results:

No measurable bone tunnel enlargement was observed around any devices.
Osseous integration occurred around all devices, with 21 of 25 showing near-complete integration (76-100%).
Two devices exhibited minimal bone marrow edema (≤25% circumference); no device breakage or other adverse findings were noted.
No device-related clinical complications were reported at a median follow-up of 36 months.

Conclusions:

Citrate-based bioceramic devices did not demonstrate the common complications associated with other resorbable materials in this small series.
The observed osseous integration and lack of adverse findings are promising for this novel resorbable implant material.
Larger, more rigorous studies are needed to independently replicate these findings and support widespread clinical recommendation.