title: Metallic or bioabsorbable interference screw for graft fixation in anterior cruciate ligament (ACL) reconstruction?
abstract: BACKGROUND
  Approximately 100,000 anterior cruciate ligament (ACL) reconstructions are performed in the USA each year. Interference screw fixation is considered the standard for rigid fixation of the graft and provides higher fixation strength compared with other devices such as staples or buttons. The present study summarizes the latest evidence comparing the effectiveness of the available classes of interference screws for fixation of ACL grafts.
  
  
  METHODS
  A comprehensive search of the CINAHL, PubMed, Google Scholar, Embase Biomedical databases and the Cochrane Central Registry of Controlled Trials was performed in March 2013. Twelve studies met our inclusion criteria.
  
  
  RESULTS
  Most studies showed no intergroup difference in terms of outcomes measured with validated clinical scores such as IKDC (International Knee Documentation Committee), Lysholm score and Tegner activity level. There was no significant difference regarding range of motion. Knee stability as evaluated with pivot shift and KT arthrometer showed a significant difference only in one study, favouring metallic interference screws. Tunnel widening is much more evident and marked patients who underwent ACL reconstruction with bioabsorbable screws, with no influence on the final clinical results achieved. Complication rates between the two screw classes were similar. The average modified Coleman methodology score was 74.67. AREAS OF UNCERTAINTY/RESEARCH NEED: The data comparing the outcomes achieved by two different materials for fixation, bioabsorbable and metallic, to be used during single-bundle ACL reconstruction, showed no significant difference in the final patient outcomes, in terms of clinical scores, clinical evaluation and imaging.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Papalia
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Vasta
authors.forename: Stefano
authors.initials: S
authors.lastname: D'Adamio
authors.forename: Antonino
authors.initials: A
authors.lastname: Giacalone
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Denaro
mesh_terms: D020341:Absorbable Implants; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001863:Bone Screws; D006801:Humans; D008670:Metals; D016896:Treatment Outcome
chemical_list: D008670:Metals
keywords: ACL fixation; ACL reconstruction; bioabsorbable screw; metallic screw