Purpose: Biodegradable interference fixation screws are widely used for anterior cruciate
ligament surgery. This study evaluated 2 issues: the clinical effectiveness of a poly-D,L-lactide
interference screw and the radiographic response. Type of Study: Prospective case series. Methods: A prospective series of anterior cruciate ligament reconstructions fixed with poly-D(2%),L(98%)-lactide
screws were evaluated at annual intervals. Inclusion criteria were unilateral knee
instability, positive Lachman and pivot-shift tests, minimum age of 16 years, and
adequate bone density. Exclusionary criteria included posterior cruciate ligament
tears and previous ligament surgery on the same knee. Tegner, Lysholm, International
Knee Documentation Committee (IKDC) activity scores, Lachman and pivot-shift tests,
and radiographs were obtained. Postoperative KT-2000 examinations were performed.
Results: Sixty-one patients with 63 knees met these criteria (39 male, 22 female), at an average
follow-up of 24 months (range, 12 to 42 months). The average postoperative Cincinnati
score was 86 (45 preoperative), median Tegner score was 6 (2 preoperative), average
Lysholm score was 89 (53 preoperative), and average IKDC activity score was 3.3 out
of 4 (1.5 preoperative). Two patients had positive postoperative Lachman tests (+1)
with no positive pivot-shift tests. The average KT-2000 manual-maximum difference
was 0.7 mm. Only 1 KT-2000 value was greater than 3 mm (4 mm). No adverse events were
encountered during screw insertion and postoperative radiographs showed bone plug
consolidation and tunnel obliteration with bone in-growth increasingly apparent at
2 and 3 years (significantly earlier than published reports using pure poly-L-lactide
screws). Conclusions: This is the first clinical report of a poly-D(2%),L(98%)-lactide interference fixation
screw. This copolymer is zinc catalyzed, instead of the conventional tin, making the
polymer more hydrophilic. The “D” isomer speeds the degradation process. These screws
worked well with no adverse events. Graft tunnel obliteration was observed at 2 and
3 years. Level of Evidence: Level 4, no or historical control.
Key Words
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© 2005 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
