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Macrophage-mediated biodegradation of poly(DL-lactide-co-glycolide) in vitro.

Biodegradation of poly-DL-lactide-co-glycolide (PLGA) both in vitro and in vivo has been well documented. However, the roles that macrophages and their fused multinucleated giant cells (MNGCs) play in this biodegradation are still unclear. The current study aimed to investigate macrophage-mediated biodegradation of PLGA thin films and of PLGA composites with hydroxyapatite (HA) and tricalcium phosphate (TCP) ceramic powders in vitro using a murine macrophage cell line (RAW 264.7). The interactions were analyzed by using cell viability assays, scanning electron microscopy, and focused ion beam microscopy. The results showed that RAW 264.7 cells effectively attached and proliferated on the PLGA films and PLGA-HA, PLGA-TCP composites. The RAW 264.7 cells were observed to aggregate and fuse to form MNGCs. The cell processes on the membrane, or pseudopodia, penetrated into the PLGA films and evidently eroded the surface. We conclude that macrophages and fused MNGCs actively respond to PLGA films as substratum and degrade the surface of this polymer.

Animals↗

In vitro tobramycin elution analysis from a novel beta-tricalcium phosphate-silicate-xerogel biodegradable drug-delivery system.

This in vitro research analyzed local tobramycin elution characteristics from a novel, biodegradable drug delivery system, consisting of a beta-TCP bone substitute, VITOSS trade mark, encapsulated with silicate xerogel prepared by the sol-gel process. Tobramycin elution from silicate-xerogel-encapsulated VITOSS was compared directly with non-silicate-xerogel-encapsulated VITOSS to assess whether xerogels are effective in delivering greater tobramycin quantities in a controllable, sustained manner crucial for microbial inhibition. Tobramycin elution characteristics indicate an initial release maximum during the first 24 h that diminishes gradually several days after impregnation. The copious tobramycin quantity eluted from the VITOSS/silicate-xerogel systems is attributed to various factors: the intrinsic ultraporosity and hydrophilicity of VITOSS, the ability of tobramycin to completely dissolve in aqueous media, tobramycin complexation with highly polar SO(4) (2-) salts that further assist dissolution, and ionic exchanges between VITOSS and the environment. Silicate-xerogel-encapsulated VITOSS eluted 60.65 and 61.31% of impregnated tobramycin, whereas non-silicate-xerogel-encapsulated VITOSS eluted approximately one-third less impregnated tobramycin, at 21.53 and 23.60%. These results suggest that silicate xerogel optimizes tobramycin elution because of its apparent biodegradability. This mechanism occurs through xerogel superficial acidic sites undergoing exchanges with various ions present in the leaching buffer. Tobramycin elution kinetics were evaluated, and demonstrate that first-order elution rate constants are considerably less when silicate xerogels are employed, following a more uniform exponential decay-type mechanism, thus bolstering controlled release. Overall, tobramycin elution rates adhere to linear-type Higuchi release profiles. Elution rate constants are initially first order, and taper into zero-order elution kinetics in the latter stages of release. Because VITOSS and silicate xerogel are completely biodegradable, essentially all impregnated tobramycin will be delivered to the surgical site after implantation.

Anti-Bacterial Agents↗

Angiogenesis, endothelial cell functions, and tumor cell growth in biodegradable and nonbiodegradable devices.

Development of tissue engineering creates multiple potentials for clinical treatment and scientific research. Biodegradable collagen matrices have been found to support simultaneous autotransplantation of hepatocytes after major liver resection. Dynamic angiogenesis in biodegradable devices (BDD) and nondegradable devices (NDD) transplanted into the renal subcapsule and subcutaneous tissue was measured by the distribution of radiolabeled red blood cells and serum albumin. The circulation, microvascular integrity, and capacities of endothelial cells (adhesion, proliferation, and migration) were investigated within 2 weeks after subcutaneous transplantation of both devices. Patterns of tumor cell growth in both devices were morphologically studied. After subcutaneous transplantation, significant angiogenesis was noted at 1 week in BDD implants and from 2 weeks and on in NDD implants, with an increase in implant blood and plasma volumes. Leakage index of radiolabeled albumin in NDD implants was significantly higher than in BDD implants, while the leakage index 2 weeks after BDD implant was similar to that in subcutaneous tissues. Adhesion, proliferation and migration rates of endothelial cells isolated from both devices were higher than from subcutaneous tissues. Endothelial proliferation and migration rates in BDD implants were significantly higher at 1 week, while in NDD at 2 weeks. Tumor cells migrated and grew on the top surface of NDD with a flattened shape, while growing within the BDD forming a round mass. Endothelial capacities, angiogenetic procedure, and biological and physical characteristics of the device contribute to patterns of tumor cell growth in the device. Biodegradable collagen matrix with three-dimensional structure is suitable for simultaneous transplantation with cells without prevascularization.

Absorbable Implants↗

Development of a biodegradable alginate carrier system for antibiotics and bone cells.

This study presents a novel biodegradable alginate delivery system for antibiotics and bone cells to treat infected bone defects. About 2 x 10(7) New Zealand rabbit mesenchymal stem cells (MSCs) and 5 mL vancomycin solution (50 mg/mL) were added to 5 mL of 2.5% (w/v) sodium alginate solution to form biodegradable antibiotic and MSCs alginate beads 3 mm in diameter. The alginate beads were then cultured in an osteogenic medium for 14 days. The profiles of antibiotics released from the alginate beads were evaluated using the method of high performance liquid chromatography (HPLC). The expression of osteogenic genes, including Cbfa1 and osteopontin, in the alginate beads was determined by reverse transcription-polymerase chain reaction (RT-PCR) analysis. The alkaline phosphatase activity, calcium level, and mineral deposition of the cultured cells within the alginate beads were assessed. Analytical results demonstrated that the concentrations of vancomycin eluted from the alginate beads were, for 14 days, well above the minimal inhibitory concentration of Staphylococcus aureus. Osteopontin and mRNA of Cbfa1 were detected and increased alkaline phosphatase activity and calcium levels were noted, as was a substantial mineral deposition in cultured MSCs. The PKH 26-labeled MSCs and vancomycin alginate beads were implanted in rabbit bony cavities for in vivo analysis. Implanted PKH 26-labeled MSCs were identified in the newly formed bony trabeculae in all specimens at 2 and 4 months after implantation and there was abundant mineral deposition. The results of in vitro study demonstrated sustained elution of vancomycin from the alginate carrier for 14 days and good osteogenic differentiation of cultured MSCs in the alginate carrier matrix. The results of in vivo study demonstrated the implanted MSCs participating in new bone formation. Based on experimental evidence, development of a biodegradable alginate carrier system for antibiotics and bone cells is possible, providing a potential treatment procedure for infected bone defects.

Alginates↗

Biodegradable nanoparticles containing protein-fatty acid complexes for oral delivery of salmon calcitonin.

Biodegradable nanoparticles containing salmon calcitonin (sCT) were formulated using protein-fatty acid complexes, and their in vitro transport against a Caco-2 cell monolayer and the extent of in vivo oral uptake were assessed. Positively charged sCT was hydrophobically ion paired to form physical complexes with fatty acid, phospholipid, and surfactant. Among the complexes, sodium oleate was used to form sCT-oleate complexes, which were characterized and formulated into biodegradable poly(lactic-co-glycolic acid) (PLGA) nanoparticles. Endocytosis of sCT nanoparticles by Caco-2 cells was studied by flow cytometry. Transcytosis of sCT across the Caco-2 monolayer was also quantitated by an ELISA method. The sCT nanoparticles were orally administered to Sprague-Dawley rats, and serum sCT was monitored. Biodegradable polymeric nanoparticles containing a loading amount of sCT as high as 2.7% (w/w) were prepared based on the complexation of sCT with sodium oleate. A greater amount of sCT nanoparticles could be delivered into Caco-2 cells compared with free sCT, and sCT could also be transported from the apical side to the basolateral side of the Caco-2 monolayer. In vivo experiments using a rat animal model showed the possibility of oral uptake of sCT. This study showed that physical complexation of sCT with amphiphilic molecules enabled the formation of sCT-loaded PLGA nanoparticles at a high loading efficiency and that sCT-PLGA nanoparticles were transported across the Caco-2 cell monolayer and were readily taken up in vivo following oral admistration.

Animals↗

Proteome analysis of Pseudomonas sp. K82 biodegradation pathways.

Pseudomonas sp. K82 is a soil bacterium that can degrade and use monocyclic aromatic compounds including aniline, 3-methylaniline, 4-methylaniline, benzoate and p-hydroxybenzoate as its sole carbon and energy sources. In order to understand the impact of these aromatic compounds on metabolic pathways in Pseudomonas sp. K82, proteomes obtained from cultures exposed to different substrates were displayed by two-dimensional gel electrophoresis and were compared to search for differentially induced metabolic enzymes. Column separations of active fractions were performed to identify major biodegradation enzymes. More than thirty proteins involved in biodegradation and other types of metabolism were identified by electrospray ionization-quadrupole time of flight mass spectrometry. The proteome analysis suggested that Pseudomonas sp. K82 has three main metabolic pathways to degrade these aromatic compounds and induces specific metabolic pathways for each compound. The catechol 2,3-dioxygenase (CD2,3) pathway was the major pathway and the catechol 1,2-dioxygenase (beta-ketoadipate) pathway was the secondary pathway induced by aniline (aniline analogues) exposure. On the other hand, the catechol 1,2-dioxygenase pathway was the major pathway induced by benzoate exposure. For the degradation of p-hydroxybenzoate, the protocatechuate 4,5-dioxygenase pathway was the major degradation pathway induced. The nuclear magnetic resonance analysis of substrates demonstrated that Pseudomonas sp. K82 metabolizes some aromatic compounds more rapidly than others (benzoate > p-hydroxybenzoate > aniline) and that when combined, p-hydroxybenzoate metabolism is repressed by the presence of benzoate or aniline. These results suggest that proteome analysis can be useful in the high throughput study of bacterial metabolic pathways, including that of biodegradation, and that inter-relationships exist with respect to the metabolic pathways of aromatic compounds in Pseudomonas sp. K82.

Aniline Compounds↗

Biodegradable implants in traumatology: a review on the state-of-the-art.

Up to now the internal fixation of fractured bones and joints has been managed by metal implants. There are certain associated disadvantages: the mechanical properties of the metals are stronger than those of cortical bone ("stress-protection"); the removal of the implants requires a second operation; an increasing number of patients are confronted with problems of sensitivity to metal components of the implants, especially nickel. About 40 different biodegradable polymers, copolymers and composites have been developed as substitutes for metal implants in internal fracture fixation. The early experimental and clinical results demonstrate their limitations. From the current point of view, it is not possible to transfer the designs and assembling principles of metal implants in orthopaedic surgery to biodegradable polymers. The attempt to simply mimic metal implants in polymers is condemned to fail from the very beginning. This is a review of the literature and of our first 100 patients operated on using implants made of self-reinforced polyglycolide acid and polydioxanone. The main difficulty with the material is the loss of stiffness in a time interval which is not long enough to guarantee bone healing. The development of a sterile sinus over the site of implantation is a problem also reported by other groups. Certain additives have to be inserted into the polymers to make them visible on conventional X-radiographs. Despite these drawbacks, however, there are indications for the isolated or adjuvant implantation of biodegradable materials. They could be employed in the treatment of osteochondral fractures and other defined injuries. The available literature on these indications will be discussed.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Biodegradability of inhaled p-aramid respirable fibre-shaped particulates: representative of other synthetic organic fibre-types?

OBJECTIVES: Biopersistence, or alternatively, biodegradability (i.e., low biopersistence) represents an important concept in fibre toxicology. The studies described below were undertaken to investigate the mechanisms through which inhaled para-aramid (p-aramid) respirable, fibre-shaped particulates (RFP) are biodegraded in the lungs of exposed rats and hamsters; in contrast, cellulose fibres, another organic fibre-type, are known to be biopersistent. To investigate the mechanisms of RFP biodegradation, we have hypothesized that lung fluids activate p-aramid RFP following deposition, and the RFP are then vulnerable to enzymatic attack in the lungs. METHODS: To test the hypothesis, p-aramid RFP or cellulose RFP were instilled into the lungs of rats and the lungs digested 24 h post-exposure using two different digestion techniques: (1) a conventional ethanolic KOH method, and (2) an enzymatic method which simulates lung enzymes. RESULTS: The enzymatic but not the KOH method artificially cleaved the p-aramid RFP recovered from rat lungs. Next, p-aramid RFP or cellulose RFP were incubated with saline or lung fluids and then processed by one of the two digestion techniques. Mean lengths of p-aramid RFP processed with KOH and evaluated by SEM were 13.4 microm; in contrast, mean lengths of p-aramid RFP samples, incubated in lung fluids and treated with the enzymatic method were 8.8 microm. The enzymatic digestion method had no discernible effect on shortening of cellulose RFP, indicating that the results with p-aramid were specific. CONCLUSIONS: Our data indicate that components of lung fluids coat and catalyze the p-aramid, thereby predisposing the RFP to enzymatic cleavage. This could play a significant mechanistic role in facilitating the transverse cleavage or shortening of inhaled p-aramid RFP in the lungs of exposed rats and hamsters.

Air Pollutants, Occupational↗

[Local liberation of IGF-I and TGF-beta 1 from a biodegradable poly(D,L-lactide) coating of implants accelerates fracture healing].

In vitro and in vivo studies have demonstrated an osteoinductive effect of growth factors like IGF-I and TGF-beta 1. However, for therapeutic use in fracture treatment, the local application of these bioactive molecules is still an unsolved problem. The controlled release of growth factors from a biodegradable coating of osteosynthetic implants could stimulate fracture healing locally. Coated implants could stabilise the fracture and work as a local drug delivery system. Previous studies demonstrated a high mechanical stability of a thin 10 microns poly(D,L-lactide) (PDLLA) coating on metallic implants that withstands even an intramedullary insertion process. After an initial peak, 80% of incorporated growth factors IGF-I and TGF-beta 1 were continuously released within 42 days. The effect of locally applied IGF-I and TGF-beta 1 from a biodegradable PDLLA coating of intramedullary implants on fracture healing were investigated in a rat model. A fracture of the right tibia of 5-month-old female Sprague-Dawley rats was stabilised with coated versus uncoated titanium K-wires. X-ray examinations and blood analysis were performed, body weight and body temperature monitored throughout the experimental period. After 42 days both tibiae were dissected for mechanical torsional testing and histomorphometric analyses. The results demonstrate a nearly completely consolidated fracture in the X-ray examinations, a significant higher maximum load and torsional stiffness in the biomechanical tests and a progressed remodeling in the histological and histomorphometric analyses after 42 days in the group treated with growth factors compared to the controls. Interestingly, the PDLLA coating itself had a positive effect on fracture healing even without incorporated growth factors. No systemic change of serum parameters including IGF-I and IGF binding proteins and no differences in body weight and body temperature were seen in any group. These findings suggest that the local application of growth factors from a biodegradable poly(D,L-lactide) coating of osteosynthetic implants accelerates fracture healing significantly without systemic side effects.

Animals↗

Intraarticular migration of a broken biodegradable interference screw after anterior cruciate ligament reconstruction.

Poly-L: -lactic acid biodegradable screws have been used effectively for graft fixation in anterior cruciate ligament (ACL) reconstruction. The overall complication rate associated with the use of this implant is low, although some authors reported complications, such as osteolysis and aseptic effusion of the knee joint. We report a case of a 29-year-old female patient with a failure of a biodegradable interference screw at 22 months after ACL reconstruction using bone-patellar tendon-bone graft. In this illustrated case, the screw broke and migrated into the knee joint. In addition, we performed a detailed review of the medical literature from 1990-2005 to identify possible causes of biodegradable screw failures. We identified six published cases of bioabsorbable interference screw failure with migration into the knee joint. Several authors have reported small diameter of the screw, poor bone quality, bone resorption, and screw divergence as potential causes for intraarticular migration of metallic interference screws. With regard to bioscrews, no specific risk factors for screw breakage and intraarticular migration have been reported. ACL reconstruction with the use of bioabsorbable interference screws for fixation is considered to be reliable. However, we need to be aware of potential problems associated with the use of this implant. Early recognition of bioscrew failure may prevent associated morbidities, such as subsequent cartilage damage.

Absorbable Implants↗

Interstitial delivery of carboplatin via biodegradable polymers is effective against experimental glioma in the rat.

PURPOSE: Carboplatin has shown promise experimentally as an antineoplastic agent against both primary central nervous system (CNS) tumors and several solid tumors that frequently metastasize to the brain. Unfortunately, carboplatin is limited in its clinical use for tumors in the CNS by systemic toxicity and poor penetration through the blood brain barrier. Recent advances in polymer technology have made feasible the intracranial implantation of a biodegradable polymer capable of local sustained delivery of chemotherapy for brain neoplasms. This study assessed the toxicity and efficacy of carboplatin delivered from intracranial sustained release polymers in the treatment of experimental gliomas in rodents. METHODS: Two biodegradable anhydride polymer systems were tested: a copolymer of 1,3-bis-(p-carboxyphenoxy propane) and sebacic acid, and a copolymer of fatty acid dimer and sebacic acid. The polymers were loaded with carboplatin and dose escalation studies evaluating toxicity were performed by implanting carboplatin-loaded polymers into the brains of rats. Next, efficacy was tested. F-98 glioma cells were injected intracranially into rats, and 5 days later polymers containing the highest tolerated doses were implanted at the site of tumor growth. The survival of animals receiving carboplatin-loaded polymer was compared with that of animals receiving intraperitoneal doses of the same agent. RESULTS: Carboplatin-polymer was well tolerated at doses up to 5% loading in both polymer systems. Locally delivered carboplatin effectively prolonged survival of rats with F98 gliomas. Maximal treatment effect was seen with 5% loading of either polymer, with median survival increased threefold over control (P < 0.004). Systemic carboplatin also significantly prolonged survival, but the best intracranial polymer dose was significantly more effective than the best systemic dose tested. CONCLUSIONS: Carboplatin can be safely delivered intracranially by biodegradable sustained- release polymers. This treatment improves survival in rodents with experimental gliomas, with locally delivered carboplatin being more effective than systemic carboplatin.

Animals↗

Basic aspects of the regeneration of small-calibre neoarteries in biodegradable vascular grafts in rats.

In this report, an overview is given of the research concerning the development of a new type of small-calibre vascular graft: a hydrophilic, microporous, compliant, biodegradable graft is presented, which functions as a temporary scaffold for the regeneration of a new arterial wall (neoartery). The basic healing process, the distinct effects of hydrophilicity, microporosity, compliance and biodegradation, the smooth muscle cell orientation and the effect of cell-seeding on this healing process in these grafts are described and discussed. It is concluded that vascular grafts, prepared from a material of optimal hydrophilicity, microporosity, compliance and rate of biodegradation, combined with smooth muscle and/or endothelial cell-seeding may provide a rapid development of a neoartery independent of the graft length.

Animals↗

Gas chromatographic studies on the biodegradation of nitrobenzene and 2,4-dinitrophenol in the nitrobenzene plant wastewater.

The biodegradation of nitrobenzene (NB) and 2,4-dinitrophenol (DNP) in NB plant wastewater has been studied using acclimated activated sludge in a batch bioreactor. The gas chromatographic (GC) monitoring shows simultaneous utilization of these two substrates, and both NB and DNP were ultimately biodegraded. The primary and ultimate biodegradation rates using GC and COD methods, respectively, are compared and reported.

Journal Article↗

Performance of RBC coupled to a polyurethane foam to biodegrade petroleum refinery wastewater.

Biological treatment of petroleum refinery wastewater was studied in a rotating biological contactor (RBC) coupled to a polyurethane foam (PUF) as a porous biomass support. The PUF was attached on both sides of biodisks. The biodegradation studies were carried out at varying hydraulic and organic loadings. COD removal efficiency of up to 87% was achieved. The results obtained in terms of biodegradation of COD, NH3-N, phenol, hydrocarbons and suspended solids in this study were compared with those in the literature. The RBC-PUF bioreactor was found to have a better performance than a conventional RBC for the biodegradation of the above mentioned parameters. A higher concentration of active biomass (77 g TVS/m2) was observed in the RBC-PUF as compared to other treatment systems. A linear relationship between COD applied and COD removed was observed for the combined four stage system as well as for the individual stages.

Journal Article↗

Biodegradation of chlorinated phenolic compounds.

Chlorophenolic compounds are generated from a number of industrial manufacturing processes including pulp and paper manufacture. These compounds are found to be toxic and recalcitrant and hence their discharge into the environment must be regulated. Slow and partial degradation of chlorophenols under aerobic and anaerobic natural environment has been observed. Aerobic biodegradation of chlorophenols proceeds through the formation of catechols while under anaerobic conditions, reductive dehalogenation is the preferred metabolic pathway. Number and position of chlorine substituents on the phenolic ring has influence on the rate and extent of biodegradation of chlorophenols. In engineered systems, acclimatization of biomass to chlorophenols markedly enhances the biodegradation ability by reducing the initial lag phase and by countering inhibition. Partial removal of chlorophenols between 40-60% is usually observed in aerobic and anaerobic processes. Removal can be enhanced by a combination of aerobic and anaerobic operations.

Journal Article↗

One-year postoperative stability of LeFort I osteotomies with biodegradable fixation: a retrospective analysis of skeletal relapse.

INTRODUCTION: The purpose of this retrospective analysis was to determine the magnitude of postoperative skeletal relapse of a maxillary LeFort I osteotomy procedure performed with fixation plates and screws composed of a biodegradable copolymer (poly-L lactic and poly-L glycolic acid). METHODS: Twenty-three consecutively treated subjects, aged 19 to 39, were diagnosed with excess vertical maxillary height or anteroposterior maxillary deficiency and treated with LeFort I impaction or advancement osteotomies. Lateral cephalometric radiographs were measured and compared for the absolute magnitude of skeletal relapse from pretreatment to immediately postoperative to 1 year after surgery. RESULTS: Correlation analysis determined that a positive relationship existed between the magnitude of the surgical movement and the magnitude of postoperative relapse. The greatest relapse for any subject in any direction was 0.940 mm (anterior nasal spine to nasion-perpendicular). The greatest average relapses were 0.249 mm horizontally (anterior nasal spine to Frankfort horizontal) and 0.141 mm vertically (M-point Frankfort horizontal). CONCLUSIONS: The most significant contribution of this study to surgical stability literature is reporting the absolute magnitudes of postoperative relapse over a 1-year period of observation. Consistent with previously published reports on postoperative stability, greater magnitudes of relapse were noted for larger surgical movements, yet the absolute values of postoperative relapse with biodegradable copolymers was clinically negligible. Biodegradable copolymers can provide excellent postoperative stability for superior and anterior maxillary surgical repositioning that appears to rival published stability measurements for rigid internal metallic fixation.

Absorbable Implants↗

Delayed biodegradation of a meniscal screw.

A biodegradable polylactide meniscal screw was removed 32 months after the original meniscal repair. It was then subjected to gel permeation chromatography and was found to have retained 64.7% of its original molecular weight. Although it is obvious that the manufacturers of biodegradable implants have succeeded in producing materials that retain their strength long enough to allow tissue healing, the question arises as to the true biodegradation time of the same implants.

Absorbable Implants↗

Primary stability of hamstring graft fixation with biodegradable suspension versus interference screws.

PURPOSE: During the early postoperative period, the stability of the fixation of a hamstring graft to the bone tunnel is the primary factor in limiting rehabilitation. The aim of this study was to evaluate if the initial fixation strength of a new suspension screw is comparable to that of the biodegradable interference screw fixation technique in the hamstring reconstruction of the anterior cruciate ligament (ACL). TYPE OF STUDY: Experimental laboratory study. METHODS: We evaluated the initial fixation strength of a biodegradable poly-L-lactide/tri-calcium phosphate (PLLA/TCP) screw that suspended the graft in the bone tunnel and compared it with the strength of an interference screw for fixation of hamstring grafts in ACL reconstruction using bovine knees. Single-cycle and cyclic loading tests were performed using a materials testing machine. RESULTS: The suspension screw provided a significantly higher yield load and ultimate failure load than the interference screw. There was no significant difference in the stiffness of both techniques. The typical failure mode for the suspension screw was fracture of the screw and for the interference screw it was slippage of the graft past the screw. In cyclic testing, both methods of fixation ran out to 1,000 cycles up to 250 N with a mean displacement of 2.6 mm (range, 1.8 to 3.3 mm) for the suspension screw and 4.1 mm (range, 2.3 to 6.0 mm) for the interference screw. Only the grafts fixed with the suspension screw survived a protocol with 1,000 cycles up to 400 N. CONCLUSIONS: Our biomechanical data suggest that hamstring graft fixation using a biodegradable PLLA/TCP suspension screw provides an alternative to interference screw fixation. CLINICAL RELEVANCE: Hamstring graft fixation using a suspension screw provides a reasonable alternative to interference screw fixation.

Absorbable Implants↗