Effect of Different Screw Materials on ACL Reconstruction With the Tape Locking Screw Technique: A Retrospective Study From the FAST Cohort

Abstract

Background: Screws for graft fixation are available in 3 different materials for anterior cruciate ligament reconstruction (ACLR) with the Tape Locking Screw (TLS) technique: titanium, poly-l-lactic acid bioabsorbable, and polyetheretherketone (PEEK).

Purpose: To compare the effect of the 3 different fixation materials on graft and implant survival after ACLR with the TLS technique.

Study design: Cohort study; Level of evidence, 3.

Methods: Included were 521 patients from the French Prospective ACL Study (FAST) cohort who underwent primary surgical ACLR with the TLS technique. Patients were divided into 3 groups depending on the type of screw material used: titanium (TLS-T group), poly-l-lactic acid bioabsorbable (TLS-B group), or PEEK (TLS-P group). The primary endpoint was a retear within 2 years after ACLR. The secondary endpoints were complication rate, return to sports rate, and functional scores. Objective and subjective functional scores-including the International Knee Documentation Committee, the Knee injury and Osteoarthritis Outcome Score (KOOS), and the Lysholm score-were evaluated preoperatively and at the 2-year follow-up. Pain was assessed with the KOOS-Pain subscore recorded pre- and postoperatively every 6 months up to 2 years. Patient satisfaction was recorded at the 2-year follow-up.

Results: No significant differences between the study groups were found in retear rates (4.4%, 4.5%, and 4.3% in the TLS-T, TLS-P, and TLS-B groups 2 years after surgery) or subjective and objective outcomes. The TLS-T group had the lowest rate of intraoperative implant-related complications (0.9%) compared with the TLS-P (4.3%) and TLS-B (7.7%) groups. Young age was a significant risk factor for retear in the TLS-T (P = .03) and TLS-B (P = .0001) groups, while a high level of sports was found to be a significant risk factor in the TLS-P (P = .04) group. All functional scores improved significantly at the 2-year follow-up (P < .0001), with no significant group difference. The KOOS-Pain subscore improved continuously with no significant group difference. The rate of return to preinjury sports was between 43.4% and 58.6%. The rate of highly satisfied patients at the final follow-up was between 86.2% and 91.8%.

Conclusion: There was no difference in retear rate or objective and subjective functional scores between implant materials for TLS ACLR in this study.

Keywords: Tape Locking Screw; anterior cruciate ligament reconstruction; bioabsorbable; polyetheretherketone; screw material; titanium.

Figure 1.

Flowchart of participant inclusion in the study. ACL, anterior cruciate ligament; ACLR, anterior cruciate ligament reconstruction.

Figure 2.

Preparation of 4 folded semitendinosus autografts. Reproduced with permission of FH Orthopaedics.

Figure 3.

(A) Retrograde reamer, (B) reaming of femoral and tibial tunnels, and (C) intra-articular appearance. Images A and B were reproduced with permission of FH Orthopaedics.

Figure 4.

(A) Graft and screw placement. (B) Fixation of tapes in the outer cortex (operative view). Figure 4A was reproduced with permission of FH Orthopaedics.

Figure 5.

The Kaplan-Meier curve estimates for the 3 study groups. TLS-B, Tape Locking Screw with bioabsorbable screws; TLS-P, Tape Locking Screw with polyetheretherketone screws; TLS-T, Tape Locking Screw with titanium screws.

Figure 6.

Changes in KOOS-Pain scores. The center black line indicates the median, the top and bottom of the boxes indicate the upper and lower quartiles, the whiskers indicate the ranges, and the circles indicate outliers. KOOS, Knee injury and Osteoarthritis Outcome Score.