No osteolysis around PEEK fixation device for anterior cruciate ligament reconstruction. A Comparative study at mean follow-up 2 years.
ESSKA Academy. Bulaïd Y. May 11, 2018; 218138; FP45-1732
Yassine Bulaïd
Yassine Bulaïd
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Objectives: PolyEtherEtherKetone (PEEK) systems allows a rigid fixation of Anterior Cruciate Ligament (ACL) reconstruction. This material does not require removal in case of revision, while hypothetically avoiding bone resorption and osteolysis around fixation devices.
The aim of our study was to evaluate bone changes around two different tibial fixations of ACL reconstructions: resorbable interference screw and non-resorbable PEEK fixation.

Methods: We included 100 consecutive patients with ACL reconstruction between January and December 2012. All procedures were performed by 2 surgeons. Fifty patients were operated on with a double bundle technique fixed by an interference screw (DBS) on the tibia, 50 were operated on with a 4-strand graft technique with PEEK cage fixation (DT4 PEEK-cage). The inclusion criteria were : patients aged from 18 to 50 years old, operated for clinically LCA rupture (laxity, pain and instability) and confirmed by MRI.
The groups were comparable in terms of gender ratio (p=0.8), sport activities (assessed using UCLA p=0.5) and mean age (p=0.3).
MRI measurements were carried-out in sagittal and axial section using a dedicated software.
The criteria for judgment were:
1.Tibial tunnel enlargement (as compared with the initial drilled diameter recorded in the surgical case reports).
2.Presence of osteolysis and/or Cyst(s)
3.Tibial tunnel filling (cross-sectional area)
4.Extent of graft-bone contact (complete, three-quarters, half, a quarter, or none of the tunnel wall).

Results: At a mean follow-up two-years, the average tunnel enlargement (as compared to drilled diameter) was 2.3 +/- 2.2 mm (0.5-5 mm) in the PEEK-DT4 group versus 4.7 +/- 2.81 mm (range, 0.5-11 mm) in the DBS group (p = 0.001).
Some osteolysis was found around every resorbable screw fixation. No evidence of bone resorbtion was found, at two years, around PEEK device. system but no osteolysis was detected around the PEEK cages.
The formation of cysts was observed in 9 knees of the DBS group versus 1 in the PEEK group (p = 0.001, Odd-Ratio 10.3 95% CI [1.3-88]). The graft filled completely the tibial tunnel in 45 cases in the PEEK group, and 37 cases in the DBS group (P = 0.029). Forty-six cases in the PEEK and 38 in the BDS group (p = 0.02) exhibited a bone-graft contact surface >3/4 of the tunnel perimeter.

Conclusions: The main result of our study is that PEEK systems reduces rate of osteolysis and cysts around tibial attachment of ACL reconstructions. Tunnels enlargement were, statistically lower when PEEK fixation were used as compared to resorbable interference screws.

ACL reconstruction, PEEK fixation, interference screws, osteolysis, tunnel enlargement
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