Abstract
Purpose
Degradable magnesium implants have received increasing interest in recent years. In anterior cruciate ligament reconstruction surgery, the well-known osteoconductive effects of biodegradable magnesium alloys may be useful. The aim of this study was to examine whether interference screws made of MgYREZr have comparable biomechanical properties to commonly used biodegradable screws and whether a different thread on the magnesium screw has an influence on the fixation strength.
Methods
Five magnesium (MgYREZr-alloy) screws were tested per group. Three different groups with variable thread designs (Designs 1, 2, and 3) were produced and compared with the commercially available bioabsorbable Bioacryl rapid polylactic-co-glycolic acid screw Milagro®. In vitro testing was performed in synthetic bone using artificial ligament fixed by an interference screw. The constructs were pretensioned with a constant load of 60 N for 30 s followed by 500 cycles between 60 N and 250 N at 1 Hz. Construct displacements between the 1st and 20th and the 21st and 500th cycles were recorded. After a 30 s break, a maximum load to failure test was performed at 1 mm/s measuring the maximum pull-out force.
Results
The maximum loads to failure of all three types of magnesium interference screws (Design 1: 1,092 ± 133.7 N; Design 2: 1,014 ± 103.3 N; Design 3: 1,001 ± 124 N) were significantly larger than that of the bioabsorbable Milagro® interference screw (786.8 ± 62.5 N) (p < 0.05). However, the greatest maximum load was found with magnesium screw Design 1. Except for a significant difference between Designs 1 and 2, there were no further significant differences among the four groups in displacement after the 20th cycle.
Conclusions
Biomechanical testing showed higher pull-out forces for magnesium compared with a commercial polymer screw. Hence, they suggest better stability and are a potential alternative. The thread geometry does not significantly influence the stability provided by the magnesium implants. This study shows the first promising results of a degradable material, which may be a clinical alternative in the future.
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References
Bach FD, Carlier RY, Elis JB, Mompoint DM, Feydy A, Judet O, Beaufils P, Vallée C (2002) Anterior cruciate ligament reconstruction with bioabsorbable polyglycolic acid interference screws: MR imaging follow-up. Radiology 225(2):541–550
Barfod G, Svendsen RN (1992) Synovitis of the knee after intraarticular fracture fixation with Biofix. Report of two cases. Acta Orthop Scand 63(6):680–681
Baums MH, Zelle BA, Schultz W, Ernstberger T, Klinger HM (2006) Intraarticular migration of a broken biodegradable interference screw after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 14(9):865–868
Castellani C, Lindtner RA, Hausbrandt P, Tschegg E, Stanzl-Tschegg SE, Zanoni G, Beck S, Weinberg AM (2011) Bone-implant interface strength and osseointegration: biodegradable magnesium alloy versus standard titanium control. Acta Biomater 7(1):432–440
Emond CE, Woelber EB, Kurd SK, Ciccotti MG, Cohen SB (2011) A comparison of the results of anterior cruciate ligament reconstruction using bioabsorbable versus metal interference screws: a meta-analysis. J Bone Joint Surg Am 93(6):572–580
Ettinger M, Wehrhahn T, Petri M, Liodakis E, Olender G, Albrecht UV, Hurschler C, Krettek C, Jagodzinski M (2012) The fixation strength of tibial PCL press-fit reconstructions. Knee Surg Sports Traumatol Arthrosc 20(2):308–314
Fink C, Benedetto KP, Hackl W, Hoser C, Freund MC, Rieger M (2000) Bioabsorbable polyglyconate interference screw fixation in anterior cruciate ligament reconstruction: a prospective computed tomography-controlled study. Arthroscopy 16(5):491–498
Hackl W, Fink C, Benedetto KP, Hoser C (2000) Transplant fixation by anterior cruciate ligament reconstruction. Metal versus bioabsorbable polyglyconate interference screw. A prospective randomized study of 40 patients. Unfallchirurg 103(6):468–474
Kousa P, Jarvinen TL, Vihavainen M, Kannus P, Järvinen M (2003) The fixation strength of six hamstring tendon graft fixation devices in anterior cruciate ligament reconstruction. Part I: femoral site. Am J Sports Med 31(2):174–181
Krappel FA, Bauer E, Harland U (2006) The migration of a BioScrew as a differential diagnosis of knee pain, locking after ACL reconstruction: a report of two cases. Arch Orthop Trauma Surg 126(9):615–620
Kuhlmann J, Bartsch I, Willbold E, Schuchardt S, Holz O, Hort N, Höche D, Heineman WR, Witte F (2013) Fast escape of hydrogen from gas cavities around corroding magnesium implants. Acta Biomater 9(10):8714–8721
Lembeck B, Wulker N (2005) Severe cartilage damage by broken poly-l-lactic acid (PLLA) interference screw after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 13(4):283–286
Morrison JB (1970) The mechanics of the knee joint in relation to normal walking. J Biomech 3(1):51–61
Nagarkatti DG, McKeon BP, Donahue BS, Fulkerson JP (2001) Mechanical evaluation of a soft tissue interference screw in free tendon anterior cruciate ligament graft fixation. Am J Sports Med 29(1):67–71
Nagels J, Stokdijk M, Rozing PM (2003) Stress shielding and bone resorption in shoulder arthroplasty. J Shoulder Elbow Surg 12(1):35–39
Pereira H, Correlo VM, Silva-Correia J, Oliveira JM, Reis RL, Espregueira-Mendes J (2013) Migration of “bioabsorbable” screws in ACL repair. How much do we know? A systematic review. Knee Surg Sports Traumatol Arthrosc 21(4):986–994
Shafer BL, Simonian PT (2002) Broken poly-l-lactic acid interference screw after ligament reconstruction. Arthroscopy 18(7):E35
Staiger MP, Pietak AM, Huadmai J, Dias G (2006) Magnesium and its alloys as orthopedic biomaterials: a review. Biomaterials 27(9):1728–1734
Waizy H, Diekmann J, Weizbauer A, Reifenrath J, Bartsch I, Neubert V, Schavan R, Windhagen H (2014) In vivo study of a biodegradable orthopedic screw (MgYREZr-alloy) in a rabbit model for up to 12 months. J Biomater Appl 28(5):667–675
Windhagen H, Radtke K, Weizbauer A, Diekmann J, Noll Y, Kreimeyer U, Schavan R, Stukenborg-Colsman C, Waizy H (2013) Biodegradable magnesium-based screw clinically equivalent to titanium screw in hallux valgus surgery: short term results of the first prospective, randomized, controlled clinical pilot study. Biomed Eng Online 12:62
Waizy H, Seitz J-M, Reifenrath J, Weizbauer A, Bach F-W, Meyer-Lindenberg A, Denkena B, Windhagen H (2013) Biodegradable magnesium implants for orthopedic applications. J Mater Sci 48(1):39–50
Witte F, Kaese V, Haferkamp H, Switzer E, Meyer-Lindenberg A, Wirth CJ, Windhagen H (2005) In vivo corrosion of four magnesium alloys and the associated bone response. Biomaterials 26(17):3557–3563
Yasuda K, Tsujino J, Tanabe Y, Kaneda K (1997) Effects of initial graft tension on clinical outcome after anterior cruciate ligament reconstruction. Autogenous doubled hamstring tendons connected in series with polyester tapes. Am J Sports Med 25(1):99–106
Zantop T, Weimann A, Schmidtko R, Herbort M, Raschke MJ, Petersen W (2006) Graft laceration and pullout strength of soft-tissue anterior cruciate ligament reconstruction: in vitro study comparing titanium, poly-d, l-lactide, and poly-d, l-lactide-tricalcium phosphate screws. Arthroscopy 22(11):1204–1210
Zhang X, Yuan G, Niu J, Fu P, Ding W (2012) Microstructure, mechanical properties, biocorrosion behavior, and cytotoxicity of as-extruded Mg–Nd–Zn–Zr alloy with different extrusion ratios. J Mech Behav Biomed Mater 9:153–162
Acknowledgments
We thank our project partner Syntellix for providing us with the magnesium alloy MgYREZr (MAGNEZIX™), and the Institute of Production Engineering and Machine Tools in Hannover for producing the screws. We are also grateful for the support of the German Research Foundation (DFG) in promoting this research within the collaborative research Project SFB 599.
Conflict of interest
The company Syntellix AG, Hannover, employs Mr. Robert Schavan and Mr. Arne Lucas; they have not influenced the collection of data or its interpretation. The other authors have no competing interests. The other authors, their immediate family, and any research foundation with which they are affiliated did not receive any other benefits from any commercial entity related to the subject of this article.
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Ezechieli, M., Ettinger, M., König, C. et al. Biomechanical characteristics of bioabsorbable magnesium-based (MgYREZr-alloy) interference screws with different threads. Knee Surg Sports Traumatol Arthrosc 24, 3976–3981 (2016). https://doi.org/10.1007/s00167-014-3325-6
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DOI: https://doi.org/10.1007/s00167-014-3325-6