From the Guidelines
Yes, a bio interference screw (BIS) used in ACL reconstruction can potentially migrate through the intact articular surface of the tibia, though this is a rare complication. Bio interference screws are designed to be bioabsorbable and gradually integrate with surrounding bone tissue, but in some cases, they can migrate from their original position. This migration can occur due to several factors including improper screw placement, inadequate fixation, premature loading of the graft, or abnormal bone resorption patterns around the screw. The migration process typically happens gradually over months to years following surgery. If a BIS migrates into the joint space through the articular surface, it can cause symptoms such as pain, swelling, mechanical symptoms like catching or locking, and potentially damage the articular cartilage. Patients experiencing new or worsening knee symptoms after ACL reconstruction, particularly after a period of successful recovery, should be evaluated for potential hardware complications including screw migration. Diagnosis typically requires imaging studies such as X-rays or MRI, and treatment often involves arthroscopic removal of the migrated screw and management of any associated articular damage.
Key Considerations
- The provided evidence does not directly address the question of bio interference screw migration, but general principles of ACL reconstruction and potential complications can be applied 1.
- Bioabsorbable screws are used to minimize long-term hardware complications, but their migration is still a possible, though rare, occurrence.
- Factors contributing to screw migration include technical errors during surgery, biological factors affecting bone healing and resorption, and mechanical factors related to graft loading and fixation.
- Clinical presentation of screw migration may include new onset of pain, swelling, or mechanical symptoms, prompting the need for diagnostic imaging and potential surgical intervention.
Management and Prevention
- Proper surgical technique, including accurate placement and secure fixation of the bio interference screw, is crucial to minimize the risk of migration.
- Postoperative rehabilitation protocols should be designed to protect the graft and promote optimal bone healing, reducing the risk of complications such as screw migration.
- Regular follow-up and monitoring for signs of hardware complications are essential in the management of patients after ACL reconstruction.
From the Research
Bio Interference Screw Migration
- The migration of a bio interference screw (BIS) used in Anterior Cruciate Ligament (ACL) reconstruction through the intact articular surface of the tibia is not directly addressed in the provided studies.
- However, the studies suggest that bioabsorbable interference screws can degrade and resorb over time, potentially leading to changes in their position or structure 2, 3.
- One study found that bioabsorbable interference screws usually degrade within one year, but full osteointegration may not be complete 3 years after surgery 2.
- Another study reported that the screw volume of a bioabsorbable interference screw decreased to 44% within a two-year follow-up period, with minor new bone formation in the screw remnants 3.
Time Frame for Migration
- The time frame for potential migration of a bio interference screw is not explicitly stated in the provided studies.
- However, the studies suggest that bioabsorbable interference screws can start to degrade and resorb within the first year after surgery, with ongoing changes over the next few years 2, 3.
- It is unclear whether the degradation and resorption of the screw could lead to migration through the intact articular surface of the tibia, but it is possible that changes in the screw's position or structure could occur over time 2, 3.
Related Complications
- The provided studies report some complications related to bioabsorbable interference screws, including screw failure, fracture, and breakage 4.
- However, these complications do not necessarily involve migration of the screw through the intact articular surface of the tibia.
- Other studies report satisfactory clinical outcomes and minimal complications with the use of bioabsorbable interference screws in ACL reconstruction 5, 6.