PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Absorbable Implants”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,117 records · Page 62Linked to original sources
PubMed2003

Tibial fixation comparison of semitendinosus-bone composite allografts fixed with bioabsorbable screws and bone-patella tendon-bone grafts fixed with titanium screws.

Tibial fixation remains the weak link of ACL reconstruction over the first 8-12 weeks postoperatively. This study compared the biomechanical properties of tibial fixation for a bone-patellar tendon-bone (BPTB) graft and a novel semitendinosus-bone composite (SBC) allograft with mixed cortical-cancellous bone dowels at each end. Seven paired, fresh frozen cadaveric knees (20-45 years) were stripped of all soft tissue attachments and randomly assigned to receive either the BPTB graft or SBC allograft. Grafts were placed into tibial tunnels via a standard protocol and secured with either a 10 mmx28 mm bioabsorbable (SBC) or titanium (BPTB) screw. Grafts were cycled ten times in a servo hydraulic device from 10-50 N prior to pull to failure testing at a rate of 20 mm/min with the force vector aligned with the tibial tunnel ("worst case scenario"). Wilcoxon Signed Rank Tests were used to evaluate biomechanical differences between graft types ( p<0.05). Tibial bone mineral density and interference screw insertion torque were statistically equivalent between graft types. The mode of failure for all constructs was direct screw and graft construct pullout from the tibial tunnel. Significant differences were not observed between graft types for maximum load at failure strength (BPTB=620.8+/-209 N vs. SBC=601.2+/-140 N, p=0.74) or stiffness (BPTB=69.8 N/mm+/-29 N/mm vs SBC=47.1+/-31.6 N/mm, p=0.24). The SBC allograft yielded significantly more displacement prior to failure than the BPTB graft (15.1+/-4.9 mm vs 9.2+/-1.3 mm, p=0.04). Increased construct displacement appeared to be due to fixation failure, with some evidence of graft tissue tearing around the sutures: Bioabsorbable screw (10 x 28 mm) fixation of the SBC allograft produced unacceptable displacement levels during testing. Further study is recommended using a titanium interference screw or a longer bioabsorbable screw for SBC graft fixation under cyclic loading conditions.

Absorbable Implants↗
PubMed2003

Tibial intercondylar eminence fractures in adults: arthroscopic treatment.

Results obtained from the surgical treatment of 15 cases of type II and III tibial intercondylar eminence fractures-according to the classification of Meyers and McKeever [12, 13]-are reported in this paper. The average age of the patients observed was 22 years (range 18-41). All patients underwent an arthroscopic procedure of reduction and fixation. We used a bioabsorbable suture in ten patients and a nonabsorbable suture in five patients. The suture was passed at the ACL insertion, then pulled out through drilled tunnels and tied onto the anterior surface of the tibial metaphysis. Two of the 15 patients treated underwent an additional arthroscopic procedure because of arthrofibrosis, 2 months after the first surgical intervention. All patients were examined clinically and radiographically with an average follow-up of 18 months. According to the IKDC scoring system, recovery of the 13 patients not undergoing additional intervention was graded as normal or near normal. In 14 patients, anterior laxity was inferior to 5 mm at the KT-1000 arthrometer evaluation. Absorbable or nonabsorbable suture fixation is effective for obtaining a secure fixation and achieves good clinical and functional mid-term results.

Absorbable Implants↗
PubMed2003

Clinical results of arthroscopic meniscal repair using biodegradable screws.

This study was performed to assess the clinical results of meniscus refixation using biodegradable Clearfix meniscal screws. Between July 1999 and June 2001 this technique was performed on 65 patients, of whom 60 (27 women, 33 men; 92%) were followed up by clinical examination after an average of 18 months (range 8-34). The average age of the patients at the time of surgery was 30 years (15-58). Two patients had already undergone a partial meniscectomy at the time of follow up; three patients had had a recurrence of typical clinical signs of a meniscal tear. The other 55 patients rated the overall clinical result as "excellent" (n=21), "good" (n=31) or "satisfactory" (n=3). The average Lysholm score [20] at the time of examination was 93 (49-100) points. The Tegner-Lysholm activity grade [29] preinjury was 5.6 (3-9), compared to a grade of 5.1 (3-9) at the follow-up examination. As a result of our study, biodegradable screws can be recommended as fixation devices with a high rate of good and excellent clinical results.

Absorbable Implants↗
PubMed2003

Migration of a broken meniscal arrow: a case report and review of the literature.

Meniscal repair is a common procedure that can be performed by the inside-out, outside-in, and all-inside techniques. The all-inside technique using the meniscal arrow is increasingly popular. We report a case in which a broken segment of a meniscal arrow was found on exploration of a subcutaneous swelling around the knee three weeks following meniscal repair.

Absorbable Implants↗
PubMed2003

The meniscus Arrow or metal screw for treatment of osteochondritis dissecans? In vitro comparison of their effectiveness.

Three draw bench tests in axial direction were conducted of the pull out forces in predrilled human condylar bone of one single meniscus Arrow, one single metal screw, and three Meniscus Arrows in one bone block, the Arrows being inserted using the standard hand instruments. Bone blocks with three meniscus Arrows were tested additionally in tangential direction, imitating shear forces. All observed values were within the range of 1 standard error (SE) or higher and exceeded the values in meniscal tissue as reported in the literature. These are much higher than the shear force during a single movement in the human knee. Most metallic devices used for fixation of the fragments in the treatment of osteochondritis dissecans must be removed in a second operation. Left in place, as with the Herbert screws, they can disturb future imaging and damage the opposite cartilage of the tibia plateau. Staples left in place can break. Finally, some metals evoke allergic reactions and, at least in animals, are potent carcinogens. Although fusion of osteochondritis dissecans fragments in their original locations fixed with noncompressive biodegradable pins has been reported, these tests show the hold of compressive meniscus Arrows in bone to contribute to a better result than noncompressive pins. Other biodegradable devices are also available for this application. However, one advantage is that using meniscus Arrows, already available in the hospital for mending ruptured menisci, saves the costs of investing in other sets of instruments and devices. Another advantage is the smaller diameter of the meniscus Arrows than that of other biodegradable devices, resulting in less damage to the fragments.

Absorbable Implants↗
PubMed2003

Arthroscopic meniscus repair: inside-out technique vs. Biofix meniscus arrow.

A retrospective study evaluated meniscal suturing using an inside-out technique vs. an all-inside technique (Biofix meniscus Arrow). Fifty-five knees in 55 patients who underwent closed meniscus repair between 1985 and 1995 were divided in two groups: 20 managed by an inside-out technique; and 35 managed by an all-inside technique. All patients underwent the same postoperative program of partial weight bearing, immediate motion, and rehabilitation of the knee. They were subjected to a clinical examination using Hospital for Special Surgery knee rating system. The mean follow-up was 13 years, 2 months (11 years, 11 months-15 years, 4 months) in the inside-out group and 6 years, 5 months (6 years-6 years 10 months) in the Biofix Arrow group. Sixteen patients also had an anterior cruciate ligament injury, of which six were repaired at the time of meniscus repair and one 6 years after meniscal repair. Thirty-nine patients had an excellent or good result (87% satisfactory outcome), three had a fair result, and three had a poor result. Meniscal suturing thus provides good clinical long-term results. The advantages of an all-inside technique include short operating time, superfluous capsular exposure, easier technique, and potentially lower risk of neurovascular lesions, especially when posterior horns are involved.

Absorbable Implants↗
PubMed2004

Fixation strength of a novel bioabsorbable expansion bolt for patellar tendon bone graft fixation: an experimental study in calf tibial bone.

This biomechanical study compares the initial fixation strength of a novel bioabsorbable two-shell expansion bolt (EB) with that of a well-established interference-screw technique in bone-patellar tendon-bone (BPTB) reconstruction in a calf model. Thirty tibia plateaus (age 5-6 months) were assigned to three groups: In groups I and II, trapezoidal bone plugs of BPTB grafts were fixed with bioabsorbable poly-L-lactide interference screws (8 x 23 mm) or titanium interference screws (8 x 25 mm) respectively. In group III, semicircular grafts were fixed using bioabsorbable poly-D, L-lactide expansion bolts (5.8/8.7 x 10 x 35 mm). The tensile axis was parallel to the bone tunnel, and the construction was loaded until failure applying a displacement rate of 1 mm per second. In group II the mean ultimate loads to failure (713 N+/-218 N) were found to be significantly higher than those of groups I (487 N+/-205 N) and III (510 N+/-133 N). Measurement of stiffness showed 45 N/mm+/-13.3 in group I, 58 N/mm+/-17.4 in group II and 46 N/mm+/-6.9 in group III, and did not demonstrate significant differences. We found a correlation between insertion torque and wedge insertion force and ultimate loads to failure in all groups (r=0.53 in group I, r =0.54 in group II, and r =0.57 in group III). Cross-section planes of bone tunnel increased by 51%, 30% and 31% respectively, following insertion of screws or expansion of bolts (p<0.05). We conclude that ACL graft fixation by means of the presented expansion bolt demonstrates a fixation strength similar to the established bioabsorbable screw fixation, and is a reasonable alternative fixation method, especially since some of the specific pitfalls of screw fixation can be avoided.

Absorbable Implants↗
PubMed2004

Internal fixation for osteochondritis dissecans of the knee.

Eight knees of seven patients with osteochondritis dissecans of the knee underwent internal fixation of the fragments. The affected location was the medial femoral condyle in four knees, the lateral femoral condyle in one knee and the patellar groove in three knees. At the time of surgery, patient age ranged from 13 to 20 years (mean 16.9 years). Open reduction and internal fixation of the unstable fragments was performed with autologous bone pegs in one knee. In the other seven knees, the procedures were carried out with biodegradable poly-L-lactide pins. At a mean follow-up of 5 years (range 4-6.8 years), seven fragments were united, whereas one knee required arthroscopic removal of the loose fragment. Neither effusion nor synovitis was noticed in any of the patients treated with biodegradable pins. The technique is simple and provides satisfactory results, suggesting a valid option for the treatment of osteochondral defects where possible.

Absorbable Implants↗
PubMed2004

Severe cartilage damage by broken poly-L-lactic acid (PLLA) interference screw after ACL reconstruction.

Poly-L-lactic acid (PLLA) bioabsorbable interference screws are widely used for fixation of tendon to bone and bone to bone in anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstructions. Complications are rare. To our knowledge this is the first report of severe chondral damage caused by late breakage of the screw. Breakage of bioscrews has only been published in cases with tendon to bone fixation.

Absorbable Implants↗
PubMed2006

Humeral head impression fracture in acute posterior shoulder dislocation: new surgical technique.

Posterior shoulder dislocation with humeral head impression fracture is rare and its early diagnosis and treatment remain a challenge for the orthopaedic surgeon. Although literature describes several surgical options, most are based on the detachment of the subscapularis or on more complex techniques that change the humeral joint anatomy even more. This report describes a new operative technique that is only slightly invasive, where the depressed chondral surface is raised to regain a normal articular contour. The chondral surface is supported by an interference biabsorbable screw and the insertion of the subscapularis tendon is left intact. Two male patients with an acute shoulder posterior dislocation associated with anteromedial impression fracture of about 40 and 50%, respectively, of the articular humeral shape were treated in our department. The average follow-up was 26 months where plain X-ray and CT scan showed an anatomical humeral surface free from signs of arthritis or necrosis. Functional results were excellent in both cases. This new technique is easy, less invasive than others and ensures a stable cartilage and subchondral support without the use of grafts.

Absorbable Implants↗
PubMed2006

Reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone graft with double biodegradable femoral pin fixation.

The purpose of this study was to evaluate the early clinical outcomes of the bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction using biodegradable cross pin fixation. The nature of this study is a prospective nonrandomized clinical outcome study. Thirty-five patients who underwent BPTB ACL reconstruction with a minimum of 2 years follow-up evaluation were included in the study. Thirty BPTB autografts and five BPTB allografts were fixed with two biodegradable 2.7 mm cross pins (Rigid Fix) on the femoral side. Clinical evaluation included International Knee Documentation Committee (IKDC), Lysholm and Tegner activity score, and Telos stress device measurements. The average Lysholm knee score was 94.7 (of 100). Twenty-four patients reported an excellent result. The other eight patients were in a good group. According to the IKDC scores, 23 (66%) patients reported normal function, 12 (34%) patients reported nearly normal function, and no (0%) patient reported abnormal or severely abnormal function. Telos stress device values were less than 3 mm of sagittal displacement in 28 patients and 5 mm in 7 patients. No patients complained that their knees gave way fully, even with moderate or strenuous activities. All of the patients have returned to their preinjury level of activity and athletic participation. Clinical results support this technique as a reliable alternative for patellar tendon fixation in ACL reconstruction.

Absorbable Implants↗
PubMed2005

Anterior cruciate ligament reconstruction using the Bio-TransFix femoral fixation device and anteromedial portal technique.

The cross-pin femoral fixation technique for soft tissue grafts is a popular option in anterior cruciate ligament (ACL) reconstruction. One of these devices is the Bio-TransFix (Arthrex Inc., Naples, FL, USA) which provides high fixation strength. According to the manufacturer, the femoral tunnel is created by placing the femoral aiming device through the tibial tunnel (transtibial technique). However, using this technique it is very difficult or even impossible to place the graft at the anatomical ACL attachment site at the "10 o'clock" position. In this report, we describe the use of the Bio-TransFix device with an anteromedial portal technique. Using this technique, the surgeon has more freedom to place the graft in an anatomical position, while combining the advantages of the excellent biomechanical properties of this device.

Absorbable Implants↗
PubMed2006

Prospective randomized clinical comparison of femoral transfixation versus bioscrew fixation in hamstring tendon ACL reconstruction--a preliminary report.

PURPOSE: The purpose of this study is to clinically evaluate hamstring tendon anterior cruciate ligament (ACL)-reconstruction using femoral fixation with bioresorbable interference screws and with a bioresorbable transfixation device. HYPOTHESIS: The ACL-reconstruction using the transfixation device at the femoral side leads to less knee laxity and therefore to a better clinical outcome for the patient. TYPE OF STUDY: Prospective randomized clinical outcome study. METHODS: From February 2002 to December 2002, a total of 68 patients with hamstring ACL reconstruction using a femoral fixation once with TransFix (n=38; m:22 and f:16; median age=28.5 range 15-47) and the second with bioscrew (BS) (n=30; m:20, f:10; median age=25.5 range 13-61) completed the follow-up period. Patients in each group got a clinical assessment at 3, 6, and 12 months after surgery. The measurement of anterior translation of the tibia has been performed using the Rolimeter device. RESULTS: No significant differences in the knee laxity testing using the Rolimeter device were seen between both groups and over time within these groups. Ninety percent of all patients had functionally normal or near normal International Knee Documentation Committee (IKDC) knee ligament ratings. The TF-group included 17 grade A, 19 grade B, and 2 grade C knees, and the BS-group had 12 grade A, 13 grade B, and 5 grade C knees. The IKDC rating, the OAK-score, the Tegner-activity-score, and the Lysholm-score did not show significant differences between the TF-group and the BS-group. CONCLUSION: We disproved our hypothesis that the transfixation technique leads to less laxity and therefore to a better clinical outcome when compared to the use of BS. The clinical results in this study clarified that this technique is an effective and safe method for femoral hamstring fixation in ACL-reconstruction. However, this technique revealed no advantage compared to the bioscrew fixation technique within the short-term follow-up.

Absorbable Implants↗
PubMed2006

Bioabsorbable screw divergence angle, not tunnel preparation method influences soft tissue tendon graft-bone tunnel fixation in healthy bone.

Bone tunnel fixation of a soft tissue tendon graft is the weak link immediately following ACL reconstruction. This biomechanical study evaluated the influence of extraction drilled or step dilated bone tunnels and bioabsorbable screw divergence on soft tissue tendon graft fixation. From an initial group of 50 available specimens, similar apparent bone mineral density porcine tibiae (1.2 +/- 0.24 g/cm2) were divided into two groups of ten specimens each. Group 1 (extraction drilled) received 9 mm diameter tunnels. Group 2 (step dilated) received 7 mm diameter tunnels that were dilated to 9 mm. Grafts were secured in tunnels using 10 mm diameter, 35 mm long tapered screws. After high resolution CT scanning to evaluate screw divergence, constructs were pretensioned on a servo hydraulic device between 10 and 50 N for 10 cycles, and isometric pretensioned at 50 N for 1 min, prior to 500 sub-maximal loading cycles (50-200 N) and load to failure testing at 20 mm/min. Wilcoxon Signed Rank tests and Mann-Whitney U-tests were used to evaluate group differences. Coefficient of determination values (r2) were calculated to further delineate statistically significant relationships. Tunnel preparation method did not display statistically significant effects on insertion torque, displacement during cyclic testing, relative stiffness during cyclic testing, load at failure, stiffness during load to failure testing or displacement during load to failure testing. Screw divergence < 15 degrees produced lower displacement and greater relative stiffness during cyclic testing and greater load at failure and stiffness during load to failure testing. Screw divergence angle displayed moderate relationships with construct displacement during cyclic testing (r2 = 0.54), stiffness during load to failure testing (r2 = 0.60), and load at failure (r2 = 0.41). Tunnel dilation does not enhance soft tissue tendon graft fixation strength in healthy bone. Bioabsorbable screw divergence of > or = 15 degrees significantly reduces soft tissue tendon graft-bone tunnel fixation.

Absorbable Implants↗
PubMed2006

Clinical results of meniscus repair with the meniscus arrow: a 4- to 8-year follow-up study.

The short-term clinical results of meniscus repair with the meniscus arrow were promising. Unfavorable outcomes were reported in two studies, with longer follow-up, raising concerns about the efficacy of this device. We retrospectively reviewed 62 patients (mean age 23.7 years; range 14-37 years) that underwent all-inside meniscus repair, using the meniscus arrow. Seventeen patients had an isolated meniscus tear (ACL intact group) and 45 patients concomitant ACL rupture that was reconstructed at the same time with the meniscus repair (ACL reconstructed group). All patients followed a non-aggressive rehabilitation protocol. Follow-up was assessed by clinical examination, Lysholm and Tegner score, IKDC knee examination form and KT-2000 arthrometry for the anteroposterior laxity of the reconstructed knees. At an average follow-up of 73 months (range 49-96 months) there were three failures (4.8%), one from the ACL intact group and two from the ACL reconstructed group. One patient developed arthrofibrosis (ACL reconstructed group) that resolved conservatively. Soft tissue irritation at the repair site was noted in three patients. In two patients the symptoms were transient. In the third patient the arrow tip was cut off under local anaesthesia due to saphenous infrapatellar branch irritation and the symptoms resolved (inappropriate arrow size). KT-2000 arthrometry showed that sagittal knee laxity was less than 3 mm in all reconstructed knees. The mean Tegner activity score decreased from 6.7 (pretrauma) to 6.2 (postoperatively). The average Lysholm score was 96, with normal or nearly normal function of all success knees, according to the IKDC knee examination form. Our results show a high clinical success rate of meniscus repair with the meniscus arrow. We found this device both safe and effective.

Absorbable Implants↗
PubMed2006

Initial fixation strength of a hybrid technique for femoral ACL graft fixation.

Aperture fixation with interference screws matching the diameter of the tunnel is associated with the risk of graft laceration and graft rotation. A hybrid fixation technique (extracortical and aperture fixation) with undersized interference screws provides a higher fixation strength when compared to an aperture fixation using only a screw matching the size of the tunnel and also reduces the risk of graft laceration. This research is an experimental laboratory study. We evaluated the initial fixation strength at time-zero of an extracortical-, a hybrid- and an aperture fixation in ACL reconstruction using extracortical buttons and different sized interference screws in porcine knees. The tests were performed using a single cycle and cyclic loading protocol. Analysis of yield load, maximum load and stiffness in the single cycle loading test showed no statistically significant differences for hybrid fixation with a 1 mm undersized screw and aperture fixation with a screw matching the size of the tunnel. Cyclic loading tests showed a statistically significant difference between hybrid and aperture fixation. The use of an undersized screw alone in aperture fixation resulted in insufficient fixation strength. The initial fixation strength of the hybrid technique with undersized screws is higher compared to an interference screw fixation alone. The hybrid fixation technique is an alternative for ACL graft fixation.

Absorbable Implants↗
PubMed2006

Mid-term clinical results of medial meniscus repair with the meniscus arrow in the unstable knee.

The medial meniscus is a secondary stabilizer to anterior tibial translation and provides significant stability, especially in an ACL-deficient knee. The purpose of this study is to evaluate the clinical outcome of medial meniscus repair in the unstable knee. Between 1997 and 2002, 11 patients, with a mean age of 25.8 years (range 15-39 years), underwent all-inside medial meniscus repair, using the Meniscus Arrow, for unstable medial meniscus tear in ACL-deficient knees. For various reasons none of these patients underwent ACL reconstruction. The average follow-up was 73 months (range 52-91 months). There were three failures (27.3%) defined as the need for reoperation and partial meniscectomy. The mean Tegner activity score decreased from 6.75 (pretrauma) to 4.5 (postoperatively). The average Lysholm and subjective IKDC scores were 83 and 77.4, respectively. Two patients were graded as B (nearly normal) and six as C (abnormal), according to the IKDC knee evaluation form. KT-2000 arthrometry demonstrated that sagittal knee laxity was more than 5 mm in all knees (side to side difference). MRI demonstrated grade three signal alterations at the repair site of meniscus in three patients and signs of cartilage damage in two patients. All patients were asymptomatic during daily activities but seven out of eight reported pain or effusion after sports. Medial meniscus repair in the ACL-deficient knee is not contraindicated. The need of reducing the level of physical activity is essential.

Absorbable Implants↗