Summary

In this prospective comparative study, after the reconstruction of an isolated ACL tear according to the DT4-TLS technique, the type of interference screw has no impact on the occurrence of adverse events and clinical outcomes at 2 years of follow-up.

Abstract

Introduction

The reconstruction of the anterior cruciate ligament (ACL) using the DT4-TLS technique uses a single hamstring tendon: the half-tendinous short graft (4 bundles). The graft is fixed in the bone tunnels via TLS (Tape Locking Screw) by interference screws. These can be bioabsorbable (in polymer alone or composite), non-absorbable (in titanium) or more recently in PEEK (PolyEtherEtherKetone). The main objective of the study was to evaluate the impact of the 3 types of screws on clinical outcomes at 2-year minimum follow-up.

Material And Methods

A comparative study based on a retrospective analysis of the data collected prospectively included a continuous series of patients, aged over 15.5, operated in 2012-2015 for primary ACL reconstruction, using the DT4-TLS technique. Exclusion criteria were associated rupture of the posterior cruciate ligament and patient refusal. Three groups were constituted according to the type of screw. The primary endpoint was the occurrence of an adverse event during the first 2 years (hematoma, haemarthrosis, septic arthritis, phlebitis, cyclops syndrome, algodystrophy and re-rupture). A calculation of number of subjects required for a non-inferiority study showed that 36 patients per group should be included. The secondary criteria were return to sport and functional scores (IKDC, KOOS, ACL-RSI) at 2 years of follow-up.

Results

521 primary ACL reconstruction were included, 344 men and 177 women, mean age 30.1 +/- 9.3 years, 507 (97.3%) athletes of which 205 (39.4%) professionals / competitors. The distribution by screw type was 229 (44%) "nonabsorbable", 222 (42.6%) "resorbable", and 70 (13.4%) "PEEK". Extra-articular plasty was associated in 66 (12.7%) patients. No statistically significant difference was found between groups on the occurrence of adverse events (p=0.85) including re-ruptures (p=0.96), the return to race (p=0.54), return to usual sport (p=0.16) and functional scores at 2 years (p>0.05). 1 patient presented an intra-osseous tibial cyst with a bioabsorbable screw.

Conclusion

In this prospective comparative study, after the reconstruction of an isolated ACL tear according to the DT4-TLS technique, the type of interference screw has no impact on the occurrence of adverse events and clinical outcomes at 2 years of follow-up.