Strategies in Trauma and Limb Reconstruction

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  18 (2023)
Volume  17 (2022)
Volume  16 (2021)
Volume  15 (2020)
Volume  14 (2019)
Volume  13 (2018)
Volume  12 (2017)
Volume  11 (2016)
Volume  10 (2015)
Volume  9 (2014)
Volume  8 (2013)
Volume  7 (2012)
Volume  6 (2011)
Volume  5 (2010)
Volume  4 (2009)
Volume  3 (2008)
Volume  2 (2007)
Volume  1 (2006)
Related articles

VOLUME 4 , ISSUE 2 ( October, 2009 ) > List of Articles

Original Article

Magnetic resonance imaging analysis of the bioabsorbable Milagro™ interference screw for graft fixation in anterior cruciate ligament reconstruction

K.-H. Frosch, T. Sawallich, G. Schütze, A. Losch, T. Walde, P. Balcarek, F. Konietschke, K. M. Stürmer

Keywords : Anterior cruciate ligament, Graft fixation, Interference screw, Milagro™ screw, Magnetic resonance imaging

Citation Information : Frosch K, Sawallich T, Schütze G, Losch A, Walde T, Balcarek P, Konietschke F, Stürmer KM. Magnetic resonance imaging analysis of the bioabsorbable Milagro™ interference screw for graft fixation in anterior cruciate ligament reconstruction. 2009; 4 (2):73-79.

DOI: 10.1007/s11751-009-0063-2

License: CC BY-NC-SA 4.0

Published Online: 01-12-2019

Copyright Statement:  Copyright © 2009; The Author(s).


Abstract

Ligament graft fixation with bioabsorbable interference screws is a standard procedure in cruciate ligament replacement. Previous screw designs may resorb incompletely, and can cause osteolysis and sterile cysts despite being implanted for several years. The aim of this study was to examine the in vivo degradation and biocompatibility of the new Milagro™ interference screw (Mitek, Norderstedt, Germany). The Milagro™ interference screw is made of 30% ß-TCP (TriCalcium phosphate) and 70% PLGA (Poly-lactic-co-glycolic acid). In the period between June 2005 and February 2006, 38 patients underwent graft fixation with Milagro™ screws in our hospital. Arthroscopic ACL reconstruction was performed using hamstring tendon grafts in all the patients. MR imaging was performed on 12 randomly selected patients out of the total of 38 at 3, 6 and 12 months after surgery. During the examination, the volume loss of the screw, tunnel enlargement, presence of osteolysis, fluid lines, edema and postoperative screw replacement by bone tissue were evaluated. There was no edema or signs of inflammation around the bone tunnels. At 3, 6 and 12 months, the tibial screws showed an average volume loss of 0, 8.1% (±7.9%) and 82.6% (±17.2%, P < 0.05), respectively. The femoral screws showed volume losses of 2.5% (±2.1%), 31.3% (±21.6%) and 92.02% (±6.3%, P < 0.05), respectively. The femoral tunnel enlargement was 47.4% (±43.8%) of the original bone tunnel volume after 12 months, and the mean tunnel volume of the tibial tunnel was −9.5% (±58.1%) compared to the original tunnel. Bone ingrowth was observed in all the patients. In conclusion, the resorption behaviour of the Milagro™ screw is closely linked to the graft healing process. The screws were rapidly resorbed after 6 months and, at 12 months, only the screw remnants were detectable. Moreover, the Milagro™ screw is biocompatible and osteoconductive, promoting bone ingrowth during resorption. Tunnel enlargement is not prevented in the first months but is reduced by bone ingrowth after 12 months.

PDF Share
  1. Bach FD, Carlier RY, Elis JB, Mompoint DM, Feydy A, Judet O (2002) Anterior cruciate ligament reconstruction with bioabsorbable polyglycolic acid interference screws: MR imaging follow-up. Radiology 225(2):541-550
  2. Barber FA, Dockery WD (2008) Long-term absorption of betatricalcium phosphate poly-L-lactic acid interference screws. Arthroscopy 24(4):441-447
  3. Barber FA, Dockery WD (2006) Long-term absorption of poly-Llactic acid interference screws. Arthroscopy 22(8):820-826
  4. Bostman O, Hirvensalo E, Makinen J, Rokkanen P (1990) Foreign body reactions to fracture fixation implants of biodegradable synthetic polymers. JBJS (Br) 72:592-596
  5. Bodde EW, Wolke JG, Kowalski RS, Jansen JA (2007) Bone regeneration of porous beta-tricalcium phosphate (Conduittrade mark TCP) and of biphasic calcium phosphate ceramic (Biosel(R) in trabecular defects in sheep. J Biomed Mater Res A 82(3):711- 722
  6. Buelow JU, Siebold R, Ellermann A (2002) A prospective evaluation of tunnel enlargement in anterior cruciate ligament reconstruction with hamstrings: extracortical versus anatomical fixation. Knee Surg, Sports Traumatol, Arthrosc 10:80-85
  7. Cain EL, Phillips BB, Charlebois SZ, Azar FM (2005) Effect of tibial tunnel dilation on pullout strength of semitendinosus-gracilis- graft in anterior cruciate ligament reconstruction. Orthopedics 28(8):779-783
  8. Clathworthy MG, Annear P, Buelow JU, Bartlett RJ (1999) Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstrings and patella tendon grafts. Knee Surg, Sports Traumatol Arthrosc 7:138-145
  9. Drogset JO, Grontvedt T, Myhr G (2006) Magnetic resonance imaging analysis of bioabsorbable interference screws used for fixation of bone-patellar tendon-bone autografts in endoscopic reconstruction of the anterior cruciate ligament. Am J Sports Med 34(7):1164-1169
  10. Fink C, Benedetto KP, Hackl W, Hoser C, Freund MC, Rieger M (2000) Bioabsorbable polyglyconate interference screw fixation in anterior cruciate ligament reconstruction: a prospective computed tomography-controlled study. Arthroscopy 16(5):491-498
  11. George MS, Dunn WR, Spindler KP (2006) Current concepts review: revision anterior cruciate ligament reconstruction. Am J Sports Med 34(12):2026-2037
  12. Herbort M, Weimann A, Zantop T, Strobel M, Raschke M, Petersen W (2006) Initial fixation strength of a new hybrid technique for femoral ACL graft fixation: the bone wedge technique. Arch Orthop Trauma Surg 127(9):769-775
  13. Hoeher J, Moller HD, Fu FH (1998) Bone tunnel enlargement after anterior cruciate ligament reconstruction: fact or fiction? Knee Surg Sports Traumatol Arthrosc 6:231-240
  14. Hunt P, Rehm O, Weiler A (2006) Soft tissue graft interference fit fixation: observations on graft insertion site healing and tunnel remodeling 2 years after ACL reconstruction in sheep. Knee Surg Sports Traumatol Arthrosc 14:1245-1251
  15. Johnson D, Harner CD, Maday MG (1994) Revision anterior cruciate ligament surgery. In: Fu F, Harner CD, Vince KG (eds) Knee surgery. Williams & Wilkins, Baltimore, MD, pp 877-895
  16. Lajtai G, Humer K, Aitzetmuller G, Unger F, Noszian I, Orthner E (1999) Serial magnetic resonance imaging evaluation of a bioabsorbable interference screw and the adjacent bone. Arthroscopy 15(5):481-488
  17. Logan M, Williams A, Myers P (2003) Is bone tunnel osseointegration in hamstring tendon autograft anterior cruciate ligament reconstruction important? Arthroscopy 19(8):E1-E3
  18. Ma CB, Francis K, Towers J, Irrgang J, Fu FH, Harner CH (2004) Hamstring anterior cruciate ligament reconstruction: a comparison of bioabsorbable interference screw and endobutton-post fixation. Arthroscopy 20:122-128
  19. Macarini L, Murrone M, Marini S, Mocci A, Ettorre GC (2004) MRI in ACL reconstructive surgery with PDLLA bioabsorbable interference screws: evaluation of degradation and osteointegration processes of bioabsorbable screws. Radiol Med 107(1- 2):47-57
  20. Montjovent MO, Mathieu L, Schmoekel H, Mark S, Bourban PE, Zambelli PY, Laurent-Applegate LA, Pioletti DP (2007) Repair of critical size defects in the rat cranium using ceramic-reinforced PLA scaffolds obtained by supercritical gas foaming. J Biomed Mater Res A 83(1):41-51
  21. Morgan CD, Gehrmann RM, Jayo MJ, Johnson CS (2002) Histologic findings with a bioabsorbable anterior cruciate ligament interference screw explant after 2.5 years in vivo. Arthroscopy 18(9):E47
  22. Radford MJ, Noakes J, Read J, Wood DG (2005) The natural history of a bioabsorbable interference screw used for anterior cruciate ligament reconstruction with a 4-strand hamstring technique. Arthroscopy 21(6):707-710
  23. Singhal MC, Holzhauer M, Powell D, Johnson DL (2008) MRI evaluation of the tibial tunnel/screw/tendon interface after ACL reconstruction using a bioabsorbable interference screw. Orthopedics 31(6):575-579
  24. Tecklenburg K, Burkart P, Hoser C, Rieger M, Fink C (2006) Prospective evaluation of patellar tendon graft fixation in anterior cruciate ligament reconstruction comparing composite bioabsorbable and allograft interference screws. Arthroscopy 22(9):993-999
  25. Warden WH, Chooljian D, Jackson DW (2008) Ten-year magnetic resonance imaging follow-up of bioabsorbable poly-L-lactic acid interference screws after anterior cruciate ligament reconstruction. Arthroscopy 24(3):371-373
  26. Warden WH, Friedman R, Teresi LM, Jackson DW (1999) Magnetic resonance imaging of bioabsorbale polylactic acid interference screws during the first 2 years after anterior cruciate ligament reconstruction. Arthroscopy 15(5):474-480
  27. Weiler A, Hoffmann RF, Stahelin AC, Helling HJ, Sudkamp NP (2000) Biodegradable implants in sports medicine: the biological base. Arthroscopy 16:305-321
  28. Zantop T, Weimann A, Schmidtko R, Herbort M, Raschke MJ, Petersen W (2006) Graft laceration and pullout strength of softtissue anterior cruciate ligament reconstruction: in vitro study comparing titanium, poly-d, l-lactide, and poly-d, l-lactide-tricalcium phosphate screws. Arthroscopy 22(11):1204-1210
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.