Operative Complications From the Use of Biodegradable Kurosawa Screws

D P Johnson

The development of interference fit screws allowed the secure fixation of the bone tendon bone patellar tendon graft in arthroscopic anterior cruciate ligament reconstruction. This procedure has become regarded as the gold standard for anterior cruciate ligament reconstruction. However complications of their use are common and include graft damage during insertion or impingement in flexion, screw protrusion, screw loosening, inadequate graft fixation, infection and tenderness around the tibial tunnel. Screw removal is sometimes necessary as a secondary procedure.

Biodegradable implants have been used in other sites particularly in the area of fracture fixation. The commonly used materials are polyglycolic and polylactic acid in varying composites. These materials have been demonstrated to be biocompatable although a very small incidence of chronic granulation and occasional sinus formation has been reported. Bioabsorpable interference fit screws have been designed for use in arthroscopic anterior cruciate ligament reconstruction. Although brittle with a pull out measured at 10% less than metallic screws, their use has many potential advantages. This study was performed to analyse the operative use of these screws./ A prospective randomised and controlled trial was performed on 50 patients undergoing arthroscopic anterior cruciate ligament reconstruction by a single surgeon. Patients were analysed clinical and radiographically pre and post-operatively. Haematological inflammatory markers were measured, KT 1000 assessment was undertaken as was the speed of their recovery and return to sporting activities.

The results demonstrate that the use of these screws required several modifications to the operative technique as one screw fractured and five cracked during insertion, but once the technique is mastered no further operative failures occurred. Recannulation of the screw with the screw driver proved difficult. The metallic screws were noted to have a higher incidence of graft damage during insertion and a higher incidence of tibial tunnel tenderness, although to date none has been removed. No peri-operative infections or failed primary wound healing occurred in either group and no significant differences were noted in the speed of recovery, haematological inflammatory markers, and bone tunnel diameter to date. The use of bioabsorpable interference screws can safely be undertaken with many advantages. However modification of the surgical technique is necessary to safely utilise the brittle and blunt bioabsorpable screws.

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