Bioabsorbable Interference Screws VS. Metal Interference Screws In Anterior Cruciate Ligament Reconstruction: A Systematic Review

Objective:Systematic review of bioabsorbable interference screw vs. metal interference screw in anterior cruciate ligament reconstruction.Method:A literature searching of PubMed, Ovid Medline, Cochrane Libarary, Embase, EBSCO, CNKI and CBM about bioabsorbable interference screw vs. metal interference screw in anterior cruciate ligament reconstruction.Hand searching of related journals. The quality of the eligible studies were assessed according to the Cochrane Handbook 5.O.We used RevMan5.0.23 to do Meta-analysis. The strength of evidence was assessed using GRADE profile.Result:Data from 1032 knees in eleven Randomized controlled trials (RCT) and one quasi-Randomized controlled trial (q-RCT) were included in the analyses. Meta-analysis results:at any follow-up intervals, there was no statistically significant differences in KT-1000/2000 test (one year follow-up: SMD 0.03,95%CI (-0.16,0.22); two year follow-up:SMD 0.06,95%CI (-0.16, 0.28)); Lachman test (one year follow-up:RR1.29,95%CI(0.63,2.61); two year follow-up:RR 0.66,95%CI(0.30,1.49)); Pivot shift test (one year follow-up: RR 1.00,95%CI (0.46,2.19), two year follow-up:RR 2.46,95% CI(0.87, 6.97)); IKDC score (one year follow-up:RR 0.73,95% CI (0.24,2.19); two year follow-up:RR 0.83,95% CI (0.44,1.57)); Lysholm score (one year follow-up:MD=-0.71,95% CI (-3.42,2.00); two year follow-up:MD 1.48, 95%CI (-0.08,3.04)); infection rates (RR 1.08,95% CI (0.45,2.60)). There was a slightly higher knee effusion rates in bioabsorbable interference screws group (RR 2.00,95% CI (1.01,3.96)). In bioabsorbable interference screw group, the tunnel enlargement was more common. GRADE results:there were 9 low quality evidences,2 very low quality evidences and 5 moderate quality evidences.Conclusion:Bioabsorbable interference screws could acquire the same efficiency compared with metal interference screw in knee stability, knee function. But in the prevention of screw breakage, bone tunnel width enlargement and knee effusion, we didn't find any advantage using bisoabsorbable screws. It should be with caution when recommend for clinical use due to the low quality of included studies, low quality of evidence and short term follow-up. Further, high quality,long term follow-up and large sample trials would be required to confirm.