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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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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DOI: https://doi.org/10.1007/s11547-008-0334-x