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Interference screw in ACL reconstruction
WHAT ARE THE REQUIRED PROPERTIES FOR GOOD SCREW AND WHICH MATERIAL IS THE BEST FOR THAT USE
ACL anatomy and rupture
University of Maryland Medical Center – http://umm.edu/health/medical/ency/presentations/anterior-cruciate-ligament-repair-series
Reconstruction
University of Maryland Medical Center – http://umm.edu/health/medical/ency/presentations/anterior-cruciate-ligament-repair-series
Degradable Interference Screw
NEC-PLUS® Interference Screw
Poly (L/DL Lactide) 70-30 absorbable screw
Screw location
M. Chizari, M. Alrashidi, K. Alrashdan, and I. Yildiz, “Mechanical Aspects of an Interference Screw Placement in ACL Reconstruction,” pp. 18–20
Material requirement
Mech
prop
Bio
comp
Bio
degPLA
M. Chizari, M. Alrashidi, K. Alrashdan, and I. Yildiz, “Mechanical Aspects of an Interference Screw Placement in ACL Reconstruction,” pp. 18–20
Mechanical prop.
K. F. Farraro, K. E. Kim, S. L. Y. Woo, J. R. Flowers, and M. B. McCullough, “Revolutionizing orthopaedic biomaterials: The potential of biodegradable and bioresorbablemagnesium-based materials for functional tissue engineering,” J. Biomech., vol. 47, no. 9, pp. 1979–1986, 2014.
892919
701000
100
200
300
400
500
600
700
800
900
1000
Yield Strength [Mpa]
AISI 316L Titanium PLA bone
210
106
4140
50
100
150
200
250
Young Modulus [Gpa]
AISI 316L Titanium PLA bone
1716
7
3
0
2
4
6
8
10
12
14
16
18
Elongation [%]
AISI 316L Titanium PLA bone
Parameters affecting Biocompatibility
Y. Ramot, M. H. Zada, A. J. Domb, and A. Nyska, “Biocompatibility and safety of PLA and its copolymers,” Adv. Drug Deliv. Rev., vol. 107, pp. 153–162, 2015.
Implant Host
Shape and sizeType of tissue
CompositionLocation in the body
Roughness of surfaceSurrounding environment
Morphology Genetics
Porosity
Sterility
Duration of contact
Parameters affecting BioDegradation
Y. Ramot, M. H. Zada, A. J. Domb, and A. Nyska, “Biocompatibility and safety of PLA and its copolymers,” Adv. Drug Deliv. Rev., vol. 107, pp. 153–162, 2015.
Implant Host
Shape and sizepH
Spatial structureTemperature
Hydro-philicity/phobicity
Surface morphology
Porosity
Sterility
Duration of contact
Why Biodegradation ?
Problems of the Traditional screw
potentially need to be removed
hinderMRI/CT
Rupture of implant
Y. Arama, L. J. Salmon, K. Sri-Ram, J. Linklater, J. P. Roe, and L. A. Pinczewski, “Bioabsorbable Versus Titanium Screws in Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft: A Prospective, Blinded, Randomized Controlled Trial With 5-Year Follow-up.,” Am. J. Sports Med., vol. 43, no. 8, pp. 1893–1901, 2015.
Stereoisomerism of PLA
isomerMonomerRepetitive unit
L
D
K. Masutani and Y. Kimura, PLA Synthesis and Polymerization. 2014.
Crystallinity
Y. Onuma and P. W. Serruys, “Bioresorbable scaffold: The advent of a new era in percutaneous coronary and peripheral revascularization?,” Circulation, vol. 123, no. 7, pp. 779–797, 2011.
L-isomer
High crystallinity
Less amorphous region
Reduce Hydration
-CH3
Hydrophobicity
Reduce degradation rate
tensile & yield
strength
Reduce elongation
S. Farah, D. G. Anderson, and R. Langer, “Physical and mechanical properties of PLA, and their functions in widespread applications - A comprehensive review,” Adv. Drug Deliv. Rev., vol. 107, pp. 367–392, 2016.
R. M. Rasal, A. V. Janorkar, and D. E. Hirt, “Poly(lactic acid) modifications,” Prog. Polym. Sci., vol. 35, no. 3, pp. 338–356, 2010.
Reduce FBR
Degradation method
Y. Onuma and P. W. Serruys, “Bioresorbable scaffold: The advent of a new era in percutaneous coronary and peripheral revascularization?,” Circulation, vol. 123, no. 7, pp. 779–797, 2011.
HydrationEster-
HydrolysisMass loss Dissolution
Y. Onuma and P. W. Serruys, “Bioresorbable scaffold: The advent of a new era in percutaneous coronary and peripheral revascularization?,” Circulation, vol. 123, no. 7, pp. 779–797, 2011.
PLA limitations
K. F. Farraro, K. E. Kim, S. L. Y. Woo, J. R. Flowers, and M. B. McCullough, “Revolutionizing orthopaedic biomaterials: The potential of biodegradable and bioresorbable magnesium-based materials for functional tissue engineering,” J. Biomech., vol. 47, no. 9, pp. 1979–1986, 2014.
1Young’s modulus similar to the bone
2Degradation
3Allow bone regeneration (?)
4Properties control (?)
5Allow MRI/CT
1Break during surgery
2Slow degradation rate
3Bad bone regeneration
4Inaccurate control
Solution for bone regeneration
3D print
Stem cell
HA coat
Hydro gel
Bone hilling
K. F. Farraro, K. E. Kim, S. L. Y. Woo, J. R. Flowers, and M. B. McCullough, “Revolutionizing orthopaedic biomaterials: The potential of biodegradable and bioresorbable magnesium-based materials for functional tissue engineering,” J. Biomech., vol. 47, no. 9, pp. 1979–1986, 2014.
Mg alloys - AZ31 | MgZnCa
K. F. Farraro, K. E. Kim, S. L. Y. Woo, J. R. Flowers, and M. B. McCullough, “Revolutionizing orthopaedic biomaterials: The potential of biodegradable and bioresorbable magnesium-based materials for functional tissue engineering,” J. Biomech., vol. 47, no. 9, pp. 1979–1986, 2014.
1.Young modulus similar to the bone = 40-45 [GPa]
2.Tensile strength greater than polymer
3.Good elongation = 16%
4.Allow MRI
5.controlled degradation time
Summery
1. ACL reconstruction is very common, hence it is extensively studied.
2. What makes successful screw is: properties similarity to the human bone, biocompatibility, accelerate bone regeneration.
3. Despite its limitations, PLA demonstrates few important benefits that justifies further research and development.
My Opinion Despite recent breakthroughs in printed metals, I think that PLA still
has major advantage over metals which is the friendly, easy and
cheap printability using FDM printers.
This will be useful especially when availability is an important factor,
for example, in orthopedic departments.
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ACL Reconstruction Team Members :,” 2005.
[2] M. Chizari, M. Alrashidi, K. Alrashdan, and I. Yildiz, “Mechanical Aspects of an Interference
Screw Placement in ACL Reconstruction,” pp. 18–20.
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[10]Y. Arama, L. J. Salmon, K. Sri-Ram, J. Linklater, J. P. Roe, and L. A. Pinczewski, “Bioabsorbable
Versus Titanium Screws in Anterior Cruciate Ligament Reconstruction Using Hamstring
Autograft: A Prospective, Blinded, Randomized Controlled Trial With 5-Year Follow-up.,” Am. J.
Sports Med., vol. 43, no. 8, pp. 1893–1901, 2015.
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