Comparison of Bioabsorbable and Metallic Interference Screws for Graft Fixation During ACL Reconstruction: A Meta-analysis of Randomized Controlled Trials

Background: Bioabsorbable interference screws and metallic interference screws are both widely used for graft fixation, but it remains unclear which screw type is superior. Purpose: To compare clinical outcomes and complications between bioabsorbable and metallic interference screws for anterior cruciate ligament reconstruction (ACLR). Study Design: Systematic review; Level of evidence, 1. Methods: The literature was searched for relevant randomized controlled trials published between 1966 and 2020. Two investigators independently assessed risk of bias in the included studies, and data were pooled to calculate mean differences (MDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes, together with 95% CIs. Meta-analysis was performed using a random- or fixed-effects model, depending on the heterogeneity in the data. Results: Included were 14 randomized controlled trials involving 1032 patients who underwent ACLR: 528 patients with bioabsorbable screws and 504 patients with metallic screws. The 2 groups did not differ significantly in International Knee Documentation Committee score (RR, 1.04; 95% CI, 0.97 to 1.11), Lysholm score (MD, 0.59; 95% CI, –0.46 to 1.63), range of motion deficit (RR, 0.95; 95% CI, 0.67 to 1.34), positive pivot-shift test (RR, 0.87; 95% CI, 0.61 to 1.24), positive Lachman test (RR, 0.82; 95% CI, 0.48 to 1.39), or KT-1000 arthrometer value (MD, 0.01; 95% CI, –0.16 to 0.18). However, bioabsorbable screws were associated with a significantly higher risk of complications (RR, 1.70; 95% CI, 1.16 to 2.50), such as graft rupture, joint effusion, and infection. Conclusion: The results of this review showed that there was no difference between metallic and bioabsorbable screws for ACLR in terms of subjective knee function or knee laxity, but metallic interference screws had fewer complications.

Biodegradable magnesium screws in elbow fracture fixation: Clinical case series

Biodegradable magnesium-based implants are innovative alternatives that potentially eliminate the need for implant removal. Recent studies have demonstrated the osteogenic properties and bacterial inhibition potentials of magnesium screws. We reported a clinical series of three elbow fracture cases, where magnesium screws were used in the treatment of one radial head and two capitellum fractures. Postoperative clinical courses were uneventful, and fracture healing occurred within 3 months. In all cases, radiolucencies were observed around implants especially in the screw head region at 2 months post-operation, but disappeared with consolidation at 1 year post-operation. All patients achieved near normal range of motion, minimal symptoms and good functional outcomes. No complication such as failure of fixation, loss of reduction, malunion or infection was seen. No implant revision or removal was necessary. Magnesium bioabsorbable screws are shown to be a viable option for these fractures.

Zastosowanie śrub biowchłanialnych w porównaniu ze śrubami metalowymi w truamatologii dziecięcej

ABSTRACTIntroduction: Metal stabilizing implants used in pediatric fractures have to be removed to not inhibit the growth of bones. Bioabsorbable implants can save children from surgical removal of the fixating material. As there have been only a few reports regarding children, we decided to evaluate the clinical advantages of bioabsorbable screws in the treatment of selected bone fractures in pediatric traumatology.Materials and methods: The study group included 35 patients with bone fractures aged 5–17 years (mean 13.2 years) fixed with LactoSorb® bioabsorbable screws made of polymeric lactic acid and polyglycolic acid. The follow-up was compared with a matched control group of 35 children that underwent operative fixation of the same type of fractures with metal screws. Results: Clinical and radiological follow-up showed that bone unions were obtained in all cases, with no signs of osteolysis. The time of immobilization was slightly shorter in the study group (5.5 weeks) than among controls (6.2 weeks; p = 0.038). There were no differences in complications, wound infections, pain management and time of hospitalization between both groups.Conclusions: The use of bioabsorbable material in the treatment of fractures in pediatric traumatology is a safe alternative to metal stabilizing devices, with clinical benefits for young patients including no necessity of a second surgery and anesthesia.