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Poly-L-lactic acid — hydroxyapatite (PLLA-HA) bioabsorbable interference screws for tibial graft fixation in anterior cruciate ligament (ACL) reconstruction surgery: MR evaluation of osteointegration and degradation features

Viti ad interferenza bioriassorbibili PLLA-HA per la fissazione tibiale di innesti nella ricostruzione di LCA: valutazione RM degli aspetti legati alla osteointegrazione e ai prodotti di degradazione

  • Musculoskeletal Radiology/Radiologia Muscolo-Scheletrica
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

We evaluated with magnetic resonance imaging (MRI) the degradation and osteointegration features of a new type of bioabsorbable interference (BioRCI) screw composed of poly-L-lactic acid and hydroxyapatite (PLLA-HA) used for tibial graft fixation in anterior cruciate ligament (ACL) reconstruction.

Materials and methods

Thirty-one patients underwent arthroscopic surgery for ACL reconstruction using doubled gracilis and semitendinosus tendons fixed to the tibial tunnel with PLLA-HA (BioRCI-HA) screws. Two groups of patients were evaluated, one group 10–13 months after surgery and the other after 30–40 months. The standard knee ligament evaluation form of the International Knee Documentation Committee (IKDC) was used for clinical assessment and MRI for the radiological assessment.

Results

MRI after 10–13 months revealed findings referable to healing and integration of the bone-graft-screw system, findings that disappeared at later follow-up examinations. The BioRCI-HA screw remained constantly visible in all patients, although with changes in signal intensity over time.

Conclusions

BioRCI-HA screws allow adequate primary stability and superior osteoconduction and biocompatibility in comparison with plain PLLA screws. The absence of ferromagnetic artefacts allows accurate MRI follow-up and adequate evaluation of ligament synovialisation, screw degradation and graft osteointegration.

Riassunto

Obiettivo

Valutare con imaging RM gli aspetti dei processi di degradazione ed osteointegrazione di una nuova classe di viti ad interferenza bioriassorbibili in acidi L-polilattici ed idrossiapatite (PLLA-HA), utilizzate per la fissazione di innesti tendinei nelle plastiche Pro-LCA.

Materiali e metodi

Trentuno pazienti sono stati sottoposti ad intervento chirurgico di ricostruzione di LCA con tendini di muscoli gracile e semitendinoso duplicati, fissati a livello del tunnel tibiale con viti PLLA-HA. Due gruppi di pazienti sono stati valutati dopo l’intervento chirurgico rispettivamente a distanza, uno di 10–13 mesi, l’altro di 30–40 mesi, utilizzando la scheda dell’International Knee Documentation Committee (IKDC) per la valutazione clinica; la valutazione radiologica è stata effettuata mediante RM.

Risultati

Dall’analisi dei risultati RM è emerso che nei controlli più ravvicinati erano presenti reperti legati ai processi di guarigione ed integrazione osso-innesto-vite, non più evidenti nel follow-up effettuato tardivamente. La vite BioRCI-HA è stata sempre visibile in tutti i controlli con modificazioni dell’intensità di segnale nel tempo.

Conclusioni

Le viti BioRCI-HA garantiscono una adeguata stabilità primaria, una superiore osteoconducibilità ed una maggiore biocompatibilità rispetto alle viti semplici di PLLA. L’assenza di artefatti ferromagnetici delle viti ha consentito un’efficace valutazione con RM dei processi di sinovializzazione del neo-legamento, di quelli di degradazione delle viti bioriassorbibili e di osteointegrazione dell’innesto.

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References/Bibliografia

  1. Kurosaka M, Yoshiya S, Andrish JT (1987) A biomechanical comparison of different surgical techniques of graft fixation in anterior cruciate ligament reconstruction. Am J Sports Med 15:225–229

    Article  PubMed  CAS  Google Scholar 

  2. Lambert KL (1994) Vascularized patellar tendon graft with rigid internal fixation for anterior cruciate ligament insufficiency. Clin Orthop 172:85–90

    Google Scholar 

  3. Ambrose CG, Clanton TO (2004) Bioabsorbable implants: review of clinical experience in orthopedic surgery. Ann Biomed Eng 32:171–177

    Article  PubMed  Google Scholar 

  4. Kousa P, Järvinen TLN, Pohjonen T et al (1995) Fixation strength of a biodegradable screw in anterior cruciate ligament reconstruction. J Bone Joint Surg Br 77:901–905

    PubMed  CAS  Google Scholar 

  5. Lajtai G, Humer K, Aitzetmuller G et al (1999) Results of reconstruction of anterior cruciate ligament ruptures: use of resorbable interference screws minimum follow-up of 2.5 years. Unfallchirurg 102:35–42

    Article  PubMed  CAS  Google Scholar 

  6. Johnson LL, VanDick GE (1996) Metal and biodegradable interference screws: comparison of failure strength. Arthroscopy 12:452–456

    PubMed  CAS  Google Scholar 

  7. Weiler A, Hoffmann RF, Stähelin AC, Helling HJ, Südkamp NP (2000) Biodegradable implants in sports medicine: the biological base. Arthroscopy 16:305–321

    PubMed  CAS  Google Scholar 

  8. Cooper DE, Wilson TW (1996) Clinical failure of tibial interference screw fixation after anterior cruciate ligament reconstruction. A report of two cases. Am J Sports Med 24:693–697

    Article  PubMed  CAS  Google Scholar 

  9. Brand J, Weiler A, Caborn DN et al (2000) Graft fixation in cruciate ligament reconstruction. Am J Sports Med 28:761–773

    PubMed  Google Scholar 

  10. Bellelli A, Ariani E, Pederzini L et al (2002) Valutazione con RM delle ricostruzioni del legamento crociato anteriore con tendine quadricipitale. Esperienza preliminare. Radiol Med 103:242–252

    PubMed  CAS  Google Scholar 

  11. Cassar-Pullicino VN, Mc Call IW, Strover AE et al (1994) MRI of the knee following prosthetic anterior cruciate ligament reconstruiction. Clin Radiol 49:89–99

    Article  PubMed  CAS  Google Scholar 

  12. Cheung Y, Magee TH, Rosenberg ZS et al (1992) MRI of anterior cruciate ligament reconstruction. J Comput Assist Tomogr 16:134–137

    PubMed  CAS  Google Scholar 

  13. Yamato M, Yamagishi T (1992) MRI of patellar tendon anterior cruciate ligament autografts. J Comput Assist Tomogr 16:604–607

    Article  PubMed  CAS  Google Scholar 

  14. Ginolfi F, Mecca ML, Gatta G et al (2001) La RM nel follow-up degli interventi di sostituzione del LCA di ginocchio: analisi retrospettiva di 54 pazienti. Radiol Med 102:205–210

    PubMed  CAS  Google Scholar 

  15. Maffulli N, Binfield PM, King JB et al (1993) Acute haemartrosis of the knee in athlettes: a prospective study of 106 cases. J Bone Joint Surg 75B:945–949

    Google Scholar 

  16. Mink JH, Reicher MA, Crues JV et al (1993) MRI of the knee. Raven Press, New York

    Google Scholar 

  17. Zarins B, Aadams M (1988) Knee injuries in sports. New Eng J Med 318:950–961

    PubMed  CAS  Google Scholar 

  18. Stoller DW (1997) Magnetic resonance imaging in orthopaedics and sports medicine. Lippincott-Raven, Philadelphia

    Google Scholar 

  19. Sanchis AV, Martinez-Sanjuan V, Gastaldi-Orquin E (1993) The value of MRI in the evaluation of the ACL deficient knee and in the post-operative evaluation after ACL reconstruction. Eur J Radiol 16:126–130

    Article  Google Scholar 

  20. Galla M, Agneskirchner JD, Lobenhoffer P (2006) Imaging of the postoperative knee. Imaging Decisions 1:31–40

    Article  Google Scholar 

  21. Tuite MJ, De Smet AA (1996) MR of the postoperative knee. Top MagnReson Imaging 8:2–14

    CAS  Google Scholar 

  22. Bellelli A, Adriani E, Margheritini M et al (1999) La maturazione sinoviale dei legamenti crociati ricostruiti. Esperienza personale a confronto negli interventi isolati e nelle ricostruzioni combinate. Radiol Med 98:454–461

    PubMed  CAS  Google Scholar 

  23. Amiel D, Kleiner JB, Roux RD et al (1986) The phenomenon of “ligamentization”: anterior cruciate ligament reconstruction with autogenous patellar tendon. J Orthop Res 4:162–172

    Article  PubMed  CAS  Google Scholar 

  24. Howell SM, Clark JA, Farley TE (1995) Revascularization of human anterior cruciate ligament graft during the first two years of implantation. Am J Sports Med 23:42–49

    Article  PubMed  CAS  Google Scholar 

  25. De Paulis F, Puddu G (1996) Ginocchio. Diagnostica per immagini e inquadramentoclinico. Idelson Gnocchi Ed, Napoli

    Google Scholar 

  26. Bach FD, Carlier RY, Elis JB et al (2002) Anterior cruciate ligament reconstruction with bioabsorbable polyglycolic acid interference screws: MR imaging followup. Radiologo 225:541–550

    Google Scholar 

  27. Macarini L, Murrone M, Marini S et al (2004) La RM negli interventi di ricostruzione del LCA con viti ad interferenza bioriassorbibili in PDLLA: valutazione dei processi di degradazione ed osteointegrazione delle viti bioriassorbibili. Radiol Med 107:47–57

    PubMed  Google Scholar 

  28. Barber FA, Dockery WD (2006) Long-term absorption of poly-L-lactic acid interference screws. Arthroscopy 22:820–826

    PubMed  Google Scholar 

  29. Walton M, Cotton NJ (2007) Long-term in vivo degradation of poly-Llactide (PLLA) in bone. J Biomat App 21:395–411

    Article  CAS  Google Scholar 

  30. Warden WH, Friedman R, Teresi LM et al (1999) Magnetic resonance imaging of bioabsorbable polylactic acid interference screws during the first 2 years after anterior cruciate ligament reconstruction. Arthroscopy 15:474–480

    PubMed  CAS  Google Scholar 

  31. Martinek V, Friederich NF (1999) Tibial and pretibial cyst formation after anterior cruciate ligament reconstruction with bioabsorbable interference screws fixation. Arthroscopy 15:317–320

    PubMed  CAS  Google Scholar 

  32. Simonian PT, Wickiewicz TL, O’Brien SJ et al (1998) Pretibial cyst formation after anterior cruciate ligament surgery with soft tissue autografts. Arthroscopy 14:215–220

    Article  PubMed  CAS  Google Scholar 

  33. McLaren DB, Buckwalter KA, Vahey TN (1992) The prevalence and significance of cyst-like changes at the cruciate ligament attachments in the knee. Skeletal Radio 16:267–274

    Google Scholar 

  34. Robinson J, Huber C, Colombet P et al (2006) Reduced bone tunnel enlargement post hamstring ACL reconstruction with poly-L-lactic acid/hydroxyapatite bioabsorbable screws. Knee 13:127–131

    Article  PubMed  Google Scholar 

  35. Cotton N, Berube N (1994) Enhancement of biocompatibility and degradation properties in a poly-Llactide/hydroxyapatite blend. In: Elliot JC (ed) Structure and chemistry of the apatites and other calcium organophosphates, studies in organic chemistry. Elsevier, Oxford

    Google Scholar 

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Authors and Affiliations

  1. Università degli Studi di Foggia, Radiodiagnostica Universitaria, Viale L. Pinto 1, 70100, Foggia, Italy

    L. Macarini, P. Milillo & R. Vinci

  2. Anthea Hospital, Via Camillo Rosalba 35, 70124, Bari, Italy

    A. Mocci

  3. Università degli Studi di Catania, Viale S. Sofia, 78, 95125, Catania, Italy

    G. C. Ettorre

  4. Via F. Chieffi 40, 70051, Barletta, Italy

    P. Milillo

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  1. L. Macarini
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  2. P. Milillo
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  3. A. Mocci
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  4. R. Vinci
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  5. G. C. Ettorre
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Correspondence to P. Milillo.

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Macarini, L., Milillo, P., Mocci, A. et al. Poly-L-lactic acid — hydroxyapatite (PLLA-HA) bioabsorbable interference screws for tibial graft fixation in anterior cruciate ligament (ACL) reconstruction surgery: MR evaluation of osteointegration and degradation features. Radiol med 113, 1185–1197 (2008). https://doi.org/10.1007/s11547-008-0334-x

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