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Resorbable screw and sheath versus resorbable interference screw and staples for ACL reconstruction: a comparison of two tibial fixation methods

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The anterior cruciate ligament (ACL) reconstruction is one of the most performed and successful orthopaedic procedures. The results are considered independent by the choice of the graft and the fixation devices. A growing interest on resorbable non-metallic fixation devices versus standard metallic fixation devices has been noted over recent years with few clinical experiences reported in the literature. The aim of this study is to compare the clinical and radiological outcomes of patients undergoing ACL reconstruction using autologous hamstring tendons with tibial fixation by a centrally placed resorbable screw and sheath to a combination of an eccentrically placed resorbable interference screw and supplementary staple fixation.

Methods

Ninety patients undergoing an isolated, single-bundle, primary ACL reconstruction with autologous hamstring tendons, using the same femoral fixation, were randomized to a tibial fixation with a centrally placed resorbable screw and sheath, BioIntrafix (group A), or an eccentrically placed resorbable interference screw, BioRCI, and two non-resorbable staples (group B). The latter has represented for many years our standard fixation method. Clinical evaluations (KOOS, IKDC, KT-2000™ side-to-side difference) and radiological analyses were conducted in both groups with a minimum follow-up of 2 years.

Results

We assisted in a satisfactory pain relief and functional improvements, without significant clinical and radiological differences in both groups. No further surgery was needed in patients with the screw/sheath tibial fixation. Seven patients with the screw/staples tibial fixation needed the surgical removal of the fixation devices due to pes anserinus irritation or local infection years after the index operation. Other parameters such as the tunnel enlargement were not statistically different in the two groups.

Conclusions

Good clinical and radiological outcomes of ACL reconstruction by a screw/sheath tibial fixation have been reported showing comparable results with respect to screw/staples fixation. There were no failures associated with loss of fixation with either of tibial fixation methods. A fewer number of surgical removals of tibial devices were also recorded in patients treated by the screw/sheath fixation system, related to the absence of local intolerance or infection compared to subjects with a standard tibial fixation.

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Acknowledgments

The authors wish to thank Marco Biondi,MD and Nicola Monteleone,MD for their precious contributions.

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Authors and Affiliations

  1. Orthopaedic Clinic, University of Florence, Largo P. Palagi 1, 50139, Florence, Italy

    Christian Carulli, Fabrizio Matassi, Stefano Soderi, Luigi Sirleo, Giovanni Munz & Massimo Innocenti

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  1. Christian Carulli
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  2. Fabrizio Matassi
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  3. Stefano Soderi
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Correspondence to Christian Carulli.

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The authors’ Institutional Review Board approved the study and follow-up, respecting the criteria of the Declaration of Helsinki; all subjects accepted the proposed treatment and follow-up after an adequate information and consent.

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The authors declare that they have no conflict of interest.

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Carulli, C., Matassi, F., Soderi, S. et al. Resorbable screw and sheath versus resorbable interference screw and staples for ACL reconstruction: a comparison of two tibial fixation methods. Knee Surg Sports Traumatol Arthrosc 25, 1264–1271 (2017). https://doi.org/10.1007/s00167-016-4135-9

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