Scripties UMCG - Rijksuniversiteit Groningen
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Choice of Tibial Hardware affects Complications after Anterior Cruciate Ligament Reconstruction

(2017) Ackerman, R.G.S.

Despite the increasing frequency of Anterior Cruciate Ligament Reconstructions (ACLRs) there is still no consensus on a few characteristics of ACLR, one of them being the recommended fixation device. Current studies mainly focus on fixation strength to avoid failure, stiffness, and patient-reported outcomes after ACLR. Complications after ACLRs are underreported. Further on, little research exists about screw removal, possibly due to complaints. The reason for Deventer Hospital (DZ) to conduct research were the complications that occurred by a fixation device which earlier had been used.
Comparing the biostable PEEK-OPTIMA TunneLoc screw versus the bioabsorbable Biointrafix Tibial Sheath and Screw used for intratibial fixation in ACLRs regarding to number of screws requiring removal, number of complaints of screw, and subjective stability.
First, all patients treated with the TunneLoc Tibial Fixation Device (Zimmer Biomet) in DZ, in the Netherlands between November 2013 and September 2014, were included. Second, a comparative cohort of patients that underwent ACLRs with use of Biointrafix Tibial Sheath and Screw (DePuy Synthes), between October 2012 and August 2013 and between September 2014 and April 2015 was selected. Femoral fixation differed between ToggleLoc Device with ZipLoop Technology (Zimmer Biomet) or Rigidfix Cross Pin System (DePuy Synthes). Exclusion criteria were: aged younger than 18 years; selected ACLR was a revision; denial of participation; and not being telephonically reachable after five tries. Data of patients was collected by telephonic interviews.
A total of 128 patients were eligible for analysis, 66 patients treated with TunneLoc and 62 treated with Biointrafix. TunneLoc screws were removed significantly more often compared with the Biointrafix (13 versus 1, p = 0.001), and patients in the TunneLoc group reported significantly more complaints (current and until removal combined) (23 versus 6, p = 0.001). Subjective stability did not differ between groups.
Our study proves that both the rate of hardware removal and the rate of complaints (current or until removal) of the Biointrafix were significantly better than of the TunneLoc screw.
Further research should focus on reporting complications and on studying the individual performance of fixation devices, symptoms and cause, risk factors, and the consequence for patients of the complication screw removal. In this research, special attention should be given to provide detailed information about the fixation device used.

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