BACKGROUND Bioabsorbable interference screws are a widely used option for graft fixation in anterior cruciate ligament(ACL)reconstruction.Their ability to degrade over time and avoid secondary hardware removal makes t...BACKGROUND Bioabsorbable interference screws are a widely used option for graft fixation in anterior cruciate ligament(ACL)reconstruction.Their ability to degrade over time and avoid secondary hardware removal makes them advantageous.However,complications such as breakage and intra-articular migration of screws can cause significant clinical issues,including joint pain,swelling,and cartilage damage.Early diagnosis and management are critical in such cases.CASE SUMMARY A 26-year-old male presented with knee pain and swelling one year after ACL reconstruction using a hamstring graft and bioabsorbable tibial interference screw.The patient had been engaged in rigorous physical activity as part of military training.Clinical examination revealed mild effusion without instability,and imaging showed screw breakage with intra-articular migration.Therapeutic arthroscopy confirmed intact graft tension,and broken screw fragments were removed successfully.The patient resumed normal activity two weeks after surgery.CONCLUSION This case highlights the potential complications associated with bioabsorbable screws,emphasizing the need for meticulous surgical technique,postoperative monitoring,and timely intervention.A comprehensive review of the literature illustrates the mechanisms,risk factors,and preventive strategies associated with screw-related complications.展开更多
For effective anterior cruciate ligament(ACL)reconstruction,an interference screw(IFS)is employed to force transplantation of the ligament into the bone tunnel.In this study,IFSs were successfully designed and pre-par...For effective anterior cruciate ligament(ACL)reconstruction,an interference screw(IFS)is employed to force transplantation of the ligament into the bone tunnel.In this study,IFSs were successfully designed and pre-pared,and the top tooth width,thread depth,and drive structure were parameterized with a forming accuracy of 80.0±21.1μm using SLA-3D printing technology.To improve the initial stability of ACL reconstruction,a biomechanical model was established,and the results were optimized through insertion torque and tensile test-ing.Consequently,the IFS with the top tooth width of 0.4 mm,thread depth of 0.8 mm,and hexagon drive,matching with theΦ8 mm bone tunnel,exhibits the best mechanical properties(maximum insertion torque of 1.064±0.117 N m,ultimate load of 446.126±37.632 N,stiffness of 66.33±27.48 N/mm).Additionally,the ZrO_(2)/PDA/RGD/Zn^(2+)bioactive coating was found to significantly improve the surface bioactivity of zirconia IFS.In conclusion,this study has significant implications for ACL reconstruction.展开更多
As one of the most promising fixators developed for anterior cruciate ligament(ACL)reconstruction,biodegradable magnesium(Mg)-based interference screws have gained increasing attention attributed to their appropriate ...As one of the most promising fixators developed for anterior cruciate ligament(ACL)reconstruction,biodegradable magnesium(Mg)-based interference screws have gained increasing attention attributed to their appropriate modulus and favorable biological properties during degradation after surgical insertion.However,its fast degradation and insufficient mechanical strength have also been recognized as one of the major causes to limit their further application clinically.This review focused on the following four parts.Firstly,the advantages of Mg or its alloys over their counterparts as orthopaedic implants in the fixation of tendon grafts in ACL reconstruction were discussed.Subsequently,the underlying mechanisms behind the contributions of Mg ions to the tendon-bone healing were introduced.Thirdly,the technical challenges of Mg-based interference screws towards clinical trials were discussed,which was followed by the introduction of currently used modification methods for gaining improved corrosion resistance and mechanical properties.Finally,novel strategies including development of Mg/Titanium(Ti)hybrid fixators and Mg-based screws with innovative structure for achieving clinically customized therapies were proposed.Collectively,the advancements in the basic and translational research on the Mg-based interference screws may lay the foundation for exploring a new era in the treatment of the tendon-bone insertion(TBI)and related disorders.展开更多
Background:Multiple techniques are commonly used for posterior cruciate ligament(PCL)reconstruction.However,the optimum method regarding the fixation of PCL reconstruction after PCL tears remains debatable.The purpose...Background:Multiple techniques are commonly used for posterior cruciate ligament(PCL)reconstruction.However,the optimum method regarding the fixation of PCL reconstruction after PCL tears remains debatable.The purpose of this study was to compare the biomechanical properties among three different tibial fixation procedures for transtibial single-bundle PCL reconstruction.Methods:Thirty-six porcine tibias and porcine extensor tendons were randomized into three fixation study groups:the interference screw fixation(IS)group,the transtibial tubercle fixation(TTF)group,and TTF+IS group(n=12 in each group).The structural properties of the three fixation groups were tested under cyclic loading and load-to-failure.The slippage after the cyclic loading test and the stiffness and ultimate failure load after load-to-failure testing were recorded.Results:After 1000 cycles of cyclic testing,no significant difference was observed in graft slippage among the three groups.For load-to-failure testing,the TTF+IS group showed a higher ultimate failure load than the TTF group and the IS group(876.34±58.78 N vs.660.92±77.74 N[P<0.001]vs.556.49±65.33 N[P<0.001]).The stiffness in the TTF group was significantly lower than that in the IS group and the TTF+IS group(92.77±20.16 N/mm in the TTF group vs.120.27±15.66 N/m in the IS group[P=0.001]and 131.79±17.95 N/mm in the TTF+IS group[P<0.001]).No significant difference in the mean stiffness was found between the IS group and the TTF+IS group(P=0.127).Conclusions:In this biomechanical study,supplementary fixation with transtibial tubercle sutures increased the ultimate failure load during load-to-failure testing for PCL reconstruction.展开更多
文摘BACKGROUND Bioabsorbable interference screws are a widely used option for graft fixation in anterior cruciate ligament(ACL)reconstruction.Their ability to degrade over time and avoid secondary hardware removal makes them advantageous.However,complications such as breakage and intra-articular migration of screws can cause significant clinical issues,including joint pain,swelling,and cartilage damage.Early diagnosis and management are critical in such cases.CASE SUMMARY A 26-year-old male presented with knee pain and swelling one year after ACL reconstruction using a hamstring graft and bioabsorbable tibial interference screw.The patient had been engaged in rigorous physical activity as part of military training.Clinical examination revealed mild effusion without instability,and imaging showed screw breakage with intra-articular migration.Therapeutic arthroscopy confirmed intact graft tension,and broken screw fragments were removed successfully.The patient resumed normal activity two weeks after surgery.CONCLUSION This case highlights the potential complications associated with bioabsorbable screws,emphasizing the need for meticulous surgical technique,postoperative monitoring,and timely intervention.A comprehensive review of the literature illustrates the mechanisms,risk factors,and preventive strategies associated with screw-related complications.
基金supported by National Key Research and Development Program of China(Grant No.2022YFB4601400)Major Basic Research Projects of Shandong Province of China(Grant No.ZR2023ZD24).
文摘For effective anterior cruciate ligament(ACL)reconstruction,an interference screw(IFS)is employed to force transplantation of the ligament into the bone tunnel.In this study,IFSs were successfully designed and pre-pared,and the top tooth width,thread depth,and drive structure were parameterized with a forming accuracy of 80.0±21.1μm using SLA-3D printing technology.To improve the initial stability of ACL reconstruction,a biomechanical model was established,and the results were optimized through insertion torque and tensile test-ing.Consequently,the IFS with the top tooth width of 0.4 mm,thread depth of 0.8 mm,and hexagon drive,matching with theΦ8 mm bone tunnel,exhibits the best mechanical properties(maximum insertion torque of 1.064±0.117 N m,ultimate load of 446.126±37.632 N,stiffness of 66.33±27.48 N/mm).Additionally,the ZrO_(2)/PDA/RGD/Zn^(2+)bioactive coating was found to significantly improve the surface bioactivity of zirconia IFS.In conclusion,this study has significant implications for ACL reconstruction.
基金This work was supported by the National Natural Science Foundation of China(Ref No.81702165)Guangdong Natural Science Fund(Ref.No.2019A1515011404)+1 种基金Key-Area Research and Development Program of Guangdong Province(Ref.No.2020B090924004)Theme-based Research Scheme(Ref No.T13-402/17-N).
文摘As one of the most promising fixators developed for anterior cruciate ligament(ACL)reconstruction,biodegradable magnesium(Mg)-based interference screws have gained increasing attention attributed to their appropriate modulus and favorable biological properties during degradation after surgical insertion.However,its fast degradation and insufficient mechanical strength have also been recognized as one of the major causes to limit their further application clinically.This review focused on the following four parts.Firstly,the advantages of Mg or its alloys over their counterparts as orthopaedic implants in the fixation of tendon grafts in ACL reconstruction were discussed.Subsequently,the underlying mechanisms behind the contributions of Mg ions to the tendon-bone healing were introduced.Thirdly,the technical challenges of Mg-based interference screws towards clinical trials were discussed,which was followed by the introduction of currently used modification methods for gaining improved corrosion resistance and mechanical properties.Finally,novel strategies including development of Mg/Titanium(Ti)hybrid fixators and Mg-based screws with innovative structure for achieving clinically customized therapies were proposed.Collectively,the advancements in the basic and translational research on the Mg-based interference screws may lay the foundation for exploring a new era in the treatment of the tendon-bone insertion(TBI)and related disorders.
文摘Background:Multiple techniques are commonly used for posterior cruciate ligament(PCL)reconstruction.However,the optimum method regarding the fixation of PCL reconstruction after PCL tears remains debatable.The purpose of this study was to compare the biomechanical properties among three different tibial fixation procedures for transtibial single-bundle PCL reconstruction.Methods:Thirty-six porcine tibias and porcine extensor tendons were randomized into three fixation study groups:the interference screw fixation(IS)group,the transtibial tubercle fixation(TTF)group,and TTF+IS group(n=12 in each group).The structural properties of the three fixation groups were tested under cyclic loading and load-to-failure.The slippage after the cyclic loading test and the stiffness and ultimate failure load after load-to-failure testing were recorded.Results:After 1000 cycles of cyclic testing,no significant difference was observed in graft slippage among the three groups.For load-to-failure testing,the TTF+IS group showed a higher ultimate failure load than the TTF group and the IS group(876.34±58.78 N vs.660.92±77.74 N[P<0.001]vs.556.49±65.33 N[P<0.001]).The stiffness in the TTF group was significantly lower than that in the IS group and the TTF+IS group(92.77±20.16 N/mm in the TTF group vs.120.27±15.66 N/m in the IS group[P=0.001]and 131.79±17.95 N/mm in the TTF+IS group[P<0.001]).No significant difference in the mean stiffness was found between the IS group and the TTF+IS group(P=0.127).Conclusions:In this biomechanical study,supplementary fixation with transtibial tubercle sutures increased the ultimate failure load during load-to-failure testing for PCL reconstruction.
