title: Meta-analysis comparing bioabsorbable versus metal interference screw for adverse and clinical outcomes in anterior cruciate ligament reconstruction.
abstract: OBJECTIVE
  To compare bioabsorbable screw (BS) against metal screw (MS) primarily on adverse effects and secondarily on clinical outcomes after single-bundle primary anterior cruciate ligament reconstruction.
  
  
  METHODS
  Electronic searches were performed using search strategies meeting the mentioned purposes. Retrieved articles were selected for randomised controlled trials (RCTs) reporting at least 1-year follow-up. Potential studies were selected under inclusion and exclusion criteria. Risk of biases and data extraction was completed by two review authors. Discrepancies were resolved through discussion. Mean difference and risk ratio with 95 % confidence interval (CI) were used for continuous and binary outcomes, respectively. Heterogeneity was assessed using I (2). Pooled treatment effects with 95 % CI were estimated using the fixed- or random-effect model where appropriate.
  
  
  RESULTS
  Eleven RCTs with 878 randomly allocated patients were included, and 711 patients (81 %) with eligible follow-up time up to 8 years were analysed. Comparing with the MS group, BS group using medial hamstring graft showed evidence of larger tunnel widening on the femoral side measured from radiographs or magnetic resonance imaging, though data could not be pooled because diverse measurement methods had been used. Significantly higher rates of effusion and screw breakage, and fewer cases of complete tunnel healing were reported in the BS group. Nevertheless, functional and clinical results were not deteriorated by the presence of these adverse effects for both short- and longer-term follow-ups.
  
  
  CONCLUSIONS
  This is the first systematic review focusing on adverse effects of the BS, such as larger tunnel widening and higher rates of other complications. With these effects, routine use of the BS should be balanced with the advantages claimed. Cost-effectiveness is another issue, and well-designed RCTs are needed to better validate the implication.
authors.affiliation: Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
authors.forename: Pat
authors.initials: P
authors.lastname: Laupattarakasem
authors.forename: Malinee
authors.initials: M
authors.lastname: Laopaiboon
authors.forename: Weerachai
authors.initials: W
authors.lastname: Kosuwon
authors.forename: Wiroon
authors.initials: W
authors.lastname: Laupattarakasem
mesh_terms: D020341:Absorbable Implants; D059549:Anterior Cruciate Ligament Reconstruction / Q000295:instrumentation* / Q000379:methods; D001182:Arthroscopy; D001672:Biocompatible Materials; D001863:Bone Screws; D003362:Cost-Benefit Analysis; D004867:Equipment Design; D005269:Femur / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008670:Metals; D016032:Randomized Controlled Trials as Topic
chemical_list: D001672:Biocompatible Materials; D008670:Metals