From the Guidelines
Osteolysis following ACL reconstruction with biocompatible screws typically occurs gradually over 2-5 years, though the timeline varies based on screw composition. The provided evidence does not directly address the timeline of osteolysis in ACL reconstruction with biocompatible screws, but it discusses osteolysis in the context of total knee arthroplasty (TKA) and its causes, diagnosis, and treatment 1. However, based on the general understanding of biocompatible materials and their behavior in the body, it is reasonable to assume that the process of osteolysis in ACL reconstruction would follow a similar pattern.
The evidence suggests that osteolysis is a leading cause of late TKA revision and can occur due to various factors, including particle debris from polyethylene, cement, and metal 1. The incidence of osteolysis is higher for cementless compared to cemented TKAs, and it can occur anywhere but is more common in certain regions of the femoral condyles and along the access channels to the cancellous bone of the tibia, including screw holes 1.
Patient factors, including age, bone quality, and metabolic rate, can influence the timeline of osteolysis, and surgeons should be aware that osteolysis may present as cyst formation or tunnel widening on imaging before complete resorption occurs 1. While biocompatible screws generally provide good clinical outcomes, patients should understand that the resorption process is lengthy and may occasionally cause mild inflammatory reactions or delayed foreign body responses.
A recent study on risk factors for knee osteoarthritis after traumatic knee injury found that ACL reconstruction with cartilage injury, partial meniscectomy, and total medial meniscectomy increases the odds of structural OA 1. However, this study does not directly address the timeline of osteolysis in ACL reconstruction with biocompatible screws.
In summary, the timeline of osteolysis in ACL reconstruction with biocompatible screws is estimated to be around 2-5 years, but this may vary based on screw composition and patient factors. Surgeons should be aware of the potential for osteolysis and monitor patients accordingly.
From the Research
Osteolysis in ACL Reconstruction with Biocompatible Screws
- Osteolysis is a potential complication in ACL reconstruction, and its occurrence can be influenced by the type of screw used 2.
- Biocompatible screws, such as bioabsorbable screws, have been developed to reduce the risk of osteolysis and other complications associated with metal screws 3, 4.
- However, the use of biocompatible screws is not without risks, and osteolysis can still occur, as reported in a case study of a patient who developed a serious foreign body reaction with wide osteolysis of both femoral and tibial tunnels following ACLR with a synthetic graft 5.
Rate of Osteolysis
- The rate of osteolysis can vary depending on the type of screw used and the individual patient's response to the screw material 6, 2.
- Bioabsorbable screws, such as those made of poly-L-lactic acid with hydroxyapatite (PLLA-HA), can resorb over time, which can lead to osteolysis 3, 6.
- The resorption rate of bioabsorbable screws can be influenced by factors such as the acidity of the screw and the environment in which it is placed 4.
Factors Influencing Osteolysis
- The type of screw material used can influence the risk of osteolysis, with some materials being more prone to causing osteolysis than others 2.
- The design of the screw and the surgical technique used can also influence the risk of osteolysis 3, 6.
- Patient-related factors, such as age and activity level, can also influence the risk of osteolysis 5.