BONE TUNNEL ENLARGEMENT WITH NON-METALLIC INTERFERENCE SCREWS IN ACL RECONSTRUCTION

ABSTRACT Objective: To compare the widening of bone tunnels between poly-etheretherketone (PEEK), absorbable polylactic acid DL (PLDL) and tricalcium phosphate (TCP) interference screws in anterior cruciate ligament (ACL) reconstruction. Methods: Three groups of patients undergoing ACL reconstruction with at least 1 year of follow-up using the out-in drilling technique and hamstring as a graft were assessed. The patients were divided according to the type of interference screw used (PEEK, PLDL and TCP). Computed tomography (CT) was performed to measure the greatest femoral and tibial tunnel widening regarding to the initial tunnel, and then it was compared between groups. Results: Mean widening in group 1 (PEEK) was 39.56% (SD 16%) in the femoral tunnel and 33.65% (SD 20%) in the tibia. In group 2 (PLDL) mean widening was 48.43% in the femoral tunnel (SD 18%) and 35.24% (SD 13%) in the tibial tunnel. In group 3 (TCP) mean widening was 44.51% in the femur (SD 14%) and 36.83% in the tibia (SD 14%). The comparison between groups (PLDL-PEEK, PLDL-TCP, PEEK-TCP) shows no statistically significant difference. Conclusion: Bone tunnel enlargement values after ACL reconstruction with the use of different types of materials (bioinert and biomaterials) of interference screws (PEEK, PLDL and TCP) were similar. Level of Evidence III, Comparative retrospective study.

摘要
目的：比较聚醚醚酮（poly-etheretherketone, PEEK）、可吸收DL聚乳酸（polylactic acid DL, PLDL）与磷酸三钙（tricalcium phosphate, TCP）界面螺钉在前交叉韧带（anterior cruciate ligament, ACL）重建术中的骨隧道扩宽情况。
方法：本研究纳入3组前交叉韧带重建术患者，所有患者均采用外入钻孔技术，以腘绳肌腱作为移植物，且术后随访时长至少1年。根据术中使用的界面螺钉类型将患者分为PEEK组、PLDL组与TCP组。通过计算机断层扫描（computed tomography, CT）测量股骨与胫骨骨隧道相对于初始隧道的最大扩宽程度，并对组间测量结果进行比较。
结果：PEEK组股骨隧道平均扩宽率为39.56%（标准差16%），胫骨隧道为33.65%（标准差20%）；PLDL组股骨隧道平均扩宽率为48.43%（标准差18%），胫骨隧道为35.24%（标准差13%）；TCP组股骨隧道平均扩宽率为44.51%（标准差14%），胫骨隧道为36.83%（标准差14%）。组间两两比较（PLDL-PEEK、PLDL-TCP、PEEK-TCP）均未发现统计学显著性差异。
结论：采用不同材质界面螺钉（生物惰性材料PEEK与生物材料PLDL、TCP）行前交叉韧带重建术后，骨隧道扩宽程度相似。本研究证据等级为Ⅲ级，属于对比性回顾性研究。