Meta-analysis of comparison of the effect of tibial fixation using absorbable screws and metal screws in anterior cruciate ligament reconstruction with autologous hamstrings

doi:10.3969/j.issn.2095-4344.3865

Abstract

Abstract: OBJECTIVE: In recent years, it has been reported that both absorbable screws and metal screws can achieve satisfactory clinical efficacy in the tibial fixation with autologous hamstring reconstruction for anterior cruciate ligament. It is necessary to conduct a meta-analysis on the two screw fixation methods. This study observed and compared the clinical outcomes of absorbable versus metal screws in the autologous hamstring tendon reconstruction of anterior cruciate ligament.
METHODS: The PubMed, The Cochrane Library, EMbase, MEDLINE (Ovid), CBM, CNKI, VIP, Baidu Scholar, and Wanfang medical databases were searched, and relevant Chinese and English orthopedic journals were searched manually. All relevant randomized control trials of absorbable versus metal screws fixation in the autologous hamstring tendon reconstruction for anterior cruciate ligament were collected. The searched period was from database inception to August 2020. Through literature screening, literature evaluation and data extraction, randomized controlled trials were assessed using the Cochrane Collaboration's recommended risk assessment tool for bias and the Jadad scale, and meta-analysis was conducted in RevMan 5.3 software.
RESULTS: (1) Eight randomized controlled trials were included, with 472 patients, including 237 cases fixed with absorbable screws and 235 cases fixed with metal screws. The risk of study bias was assessed as low risk, and the modified Jadad score was above 4, indicating high-quality studies. (2) The results of meta-analysis showed there were no statistically significant differences in postoperative anterior cruciate ligament rerupture, Lysholm score, IKDC normal grading, KT-1000, Lanchman test, Pivot test and postoperative infection between the absorbable screw group and the metal screw group (P > 0.05). However, the metal screw group had an advantage in bone ingrowth compared to the absorbable screw group (RR=0.16, 95%CI:0.03-0.84, P=0.03].
CONCLUSION: The effects of stability and function recovery of the knee after operation between the absorbable screw group and metal screw group were comparable in the tibial fixation of autologous hamstring reconstruction for anterior cruciate ligament, but metal screws are more conducive to bone ingrowth than absorbable screws. In clinics, metal screws can be recommended to replace absorbable screws for fixation, but there are few included studies, and more evidence of randomized controlled trials is needed.

Key words: soft tissue, bone, ligament, anterior cruciate ligament, hamstring muscle, absorbable screw, metal screw, meta-analysis

CLC Number:

Xiong Xiaolong, Wang Guangji, Fang Yehan, Du Xiufan, Hang Hui, Ye Zhifang. Meta-analysis of comparison of the effect of tibial fixation using absorbable screws and metal screws in anterior cruciate ligament reconstruction with autologous hamstrings[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(21): 3438-3444.

Figures/Tables 12

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