Migration of “bioabsorbable” screws in ACL repair. How much do we know? a systematic review

Abstract

Purpose Although bioabsorbable screws promise to degrade within months up to several years after implantation, often this does not happen. In fact, other problems such as screw breakage, tunnel enlargement, allergic or foreign body reactions, cyst or abscess formation, and delayedmigration of ‘‘biodegradable’’ screws have been reported. This study aims to provide relevant basic science knowledge and recent insights concerning ‘‘biomaterials’’ currently used in fixation devices for anterior cruciate ligament (ACL) repair. A systematic reviewon the topic of screw ‘‘migration’’ is provided. Methods A PubMed search combining all the key terms was done looking for complications related to late migration of ‘‘bioabsorbable’’ screws used in ACL reconstruction without inferior time limitation up to January 2012. Only clinical reports were included. Reference lists of reports were checked to detect others not identified by the original search. A pre-publication search was performed to identify the most recent relevant articles. Results A total of ten articles referred to migration of ‘‘bioabsorbable’’ interference screws. Most cases reported on poly-L-lactic acid-based screws. Migration was noticed between 3 and 22 months postoperatively. It was noticed both in the tibia and the femur and with the application of several types of graft. Conclusion Migration is a possible complication of ‘‘bioabsorbable’’ interference screws. The information related to all clinical implications of the so-called ‘‘biodegradable screws’’ remains scarce and probably suffers from the phenomenon of publication bias. The complexity of possible reactions occurring in the human body is difficult to reproduce under controlled laboratory conditions. Level of evidence Systematic review including casereports, Level V.