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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2021

Open Access 01-12-2021 | Case report

Extra-articular migration of PEEK interference screw after anterior cruciate ligament reconstruction: a report of two cases

Authors: Chao-Hua Fang, Ming Li, Yun-Feng Zhang, Hua Liu

Published in: BMC Musculoskeletal Disorders | Issue 1/2021

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Abstract

Background

The interference screw is the most popular device that fixes the graft for anterior cruciate ligament reconstruction, reducing the incidence of windshield effect and bungee effect. For the screw, either metallic, “bioresorbable,” or polyetheretherketone (PEEK) material is available. PEEK is popular and extensively used due to its stability, biocompatibility, radiolucency, and elastic modulus. Rare relevant complications were reported, but here, we report two cases of extra-articular migrations of PEEK interference screw from the tibial tunnel after anterior cruciate reconstruction.

Case report

An 18-year-old boy and a 56-year-old woman underwent anterior cruciate ligament reconstruction using a PEEK interference screw to fix the graft in the tibial tunnel. They suffered from screw extrusion from the tibial tunnel after 40 days and six months, respectively, with an incision rupture or palpable subcutaneous mass. They underwent a second operation and recovered well.

Conclusions

The exact incidence of extra-articular migrations of PEEK interference screws is unknown, but it seems to be quite low; despite this and its uncertain cause, the negative effects caused by the PEEK material need to be considered.
Literature
1.
Bourke HE, Gordon DJ, Salmon LJ, Waller A, Linklater J, Pinczewski LA. The outcome at 15 years of endoscopic anterior cruciate ligament reconstruction using hamstring tendon autograft for ‘‘isolated’’ anterior cruciate ligament rupture. J Bone Joint Surg Br. 2012;94(5):630–7.CrossRef
2.
Chevallier R, Klouche S, Gerometta A, Bohu Y, Herman S, Lefevre N. Bioabsorbable screws, whatever the composition, can result in symptomatic intra-osseous tibial tunnel cysts after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2019;27(1):76–85.CrossRef
3.
Christodoulidis A, Barbareschi M, Molinari M. A Delayed Formation of Pretibial Pseudocyst After Anterior Cruciate Reconstruction from Bioabsorbable Interference Screws: A Report of Two Cases and Short Review of the Literature. J Long Term Eff Med Implants. 2018;28(3):215–21.CrossRef
4.
Kramer DE, Kalish LA, Kocher MS, Yen YM, Micheli LJ, Heyworth BE. Complications of Bioabsorbable Tibial Interference Screws After Anterior Cruciate Ligament Reconstruction in Pediatric and Adolescent Athletes. Orthop J Sports Med. 2020;8(2):2325967120904010.CrossRef
5.
Shumborski S, Heath E, Salmon LJ, Roe JP, Pinczewski LA. A randomized controlled trial of peek versus titanium interference screws for anterior cruciate ligament reconstruction with 2-year follow-up. Am J Sports Med. 2019;47(10):2386–93.CrossRef
6.
Kurtz SM, Devine JN. PEEK biomaterials in trauma, orthopedic, and spinal implants. Biomaterials. 2007;28(32):4845–69.CrossRef
7.
Bartelstein MK, Van Citters DW, Weiser MC, Moucha CS. Failure of a Polyaryletheretherketone-Cobalt-Chromium Composite Femoral Stem Due to Coating Separation and Subsidence: A Case Report. JBJS Case Connect. 2017;7(4):e83.CrossRef
8.
Hak DJ, Fader R, Baldini T, Chadayammuri VBS. Locking screw-plate interface stability in carbon-fibre reinforced polyetheretherketone proximal humerus plates. Int Orthop. 2017;41(9):1735–9.CrossRef
9.
Krause KL, Obayashi JT, Bridges KJ, Raslan AM, Than KD. Fivefold higher rate of pseudarthrosis with polyetheretherketone interbody device than with structural allograft used for 1-level anterior cervical discectomy and fusion. J Neurosurg Spine. 2018;30(1):46–51.CrossRef
10.
Qiu S, You W, Wang H, Zhou X, Yang X. Allergic Epidural Effusion Following Polyetheretherketone Cranioplasty. J Craniofac Surg. 2019;30(3):e241–3.CrossRef
11.
Uzumcugil O, Yalcinkaya M, Ozturkmen Y, Dikmen G, Caniklioglu M. Effect of PEEK polymer on tunnel widening after hamstring ACL reconstruction. Orthopedics. 2012;35(5):e654–9.CrossRef
12.
Uzumcugil O, Dogan A, Dalyaman E, Yalcinkaya M, Akman E, Ozturkmen Y, Caniklioglu M. AperFix versus transfix in reconstruction of anterior cruciate ligament. J Knee Surg. 2010;23(1):29–35.CrossRef
13.
Hallett A, Mohammed A. Displaced femoral interference screw causing locked knee. Injury. 2003;34(10):797–8.CrossRef
14.
Moonot P, Allen P. Intra-articular pull out of an interference screw after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2006;14(9):862–4.CrossRef
15.
Resinger C, Vécsei V, Heinz T, Nau T. The removal of a dislocated femoral interference screw through a posteromedial portal. Arthroscopy. 2005;21(11):1398.CrossRef
16.
Bush-Joseph CA, Bach BR Jr. Migration of femoral interference screw after anterior cruciate ligament reconstruction. Am J Knee Surg. 1998;11(1):32–4.PubMed
17.
Karlakki SL, Downes ME. Intra-articular migration of femoral interference screw: Open or arthroscopic removal. Arthroscopy. 2003;19(3):E19.CrossRef
18.
Sidhu DS, Wroble RR. Intraarticular migration of a femoral interference fit screw. A complication of anterior cruciate ligament reconstruction. Am J Sports Med. 1997;25(2):268–71.CrossRef
19.
Helito CP, Foni NO, Bonadio MB, Pécora JR, Demange MK, Angelini FJ. Extra-articular and transcutaneous migration of the poly-l/d-lactide interference screw after popliteal tendon reconstruction. Rev Bras Ortop. 2017;52(2):233–7.CrossRef
20.
Pereira H, Correlo VM, Silva-Correia J, Oliveira JM, Reis RL, Espregueira-Mendes J. Migration of “bioabsorbable” screws in ACL repair. How much do we know? A systematic review. Knee Surg Sports Traumatol Arthrosc. 2013;21(4):986–94.CrossRef
21.
Kofler L, Wambacher M, Schweinzer K, Scherl M, Kofler H. Allergic Reaction to Polyether Ether Ketone Following Cross-Reactivity to Epoxy Resin. J Cutan Med Surg. 2017;21(1):78–9.CrossRef
22.
Maldonado-Naranjo AL, Healy AT, Kalfas IH. Polyetheretherketone (PEEK) intervertebral cage as a cause of chronic systemic allergy: a case report. Spine J. 2015;15(7):e1–3.CrossRef
23.
Karjalainen T, Pamilo K, Reito A. Implant Failure After Motec Wrist Joint Prosthesis Due to Failure of Ball and Socket-Type Articulation-Two Patients With Adverse Reaction to Metal Debris and Polyether Ether Ketone. J Hand Surg Am. 2018;43(11):1044.e1-1044.e4.CrossRef
24.
Shimizu T, Fujibayashi S, Yamaguchi S, Otsuki B, Matsuda S. In vivo experimental study of anterior cervical fusion using bioactive polyetheretherketone in a canine model. Plos One. 2017;12(9):e0184495.CrossRef
25.
Olivares-Navarrete R, Gittens RA, Schneider JM, Hyzy SL, Haithcock DA, Ullrich PF, Schwartz Z, Boyan BD. Osteoblasts exhibit a more differentiated phenotype and increased bone morphogenetic protein production on titanium alloy substrates than on polyether-ether-ketone. Spine J. 2012;12(3):265–72.CrossRef
26.
Olivares-Navarrete R, Hyzy SL, Slosar PJ, Schneider JM, Schwartz Z, Boyan BD. Implant materials generate different peri-implant inflammatory factors: poly-ether-ether-ketone and promotes fibrosis and microtextured titanium promotes osteogenic factors. Spine. 2015;40(6):399–404.
27.
Barkarmo S, Östberg AK, Johansson CB, Franco-Tabares S, Johansson PH, Dahlgren U, Stenport V. Inflammatory cytokine release from human peripheral blood mononuclear cells exposed to polyetheretherketone and titanium-6 aluminum-4 vanadium in vitro. J Biomater Appl. 2018;33(2):245–58.CrossRef
28.
Toth JM, Wang M, Estes BT, Scifert JL, Seim HB III, Turner AS. Polyetheretherketone as a biomaterial for spinal applications. Biomaterials. 2006;27:324–34.CrossRef
29.
Du Z, Zhu Z, Wang Y. The degree of peri-implant osteolysis induced by PEEK, CoCrMo, and HXLPE wear particles: a study based on a porous Ti6Al4V implant in a rabbit model. J Orthop Surg Res. 2018;13(1):23.CrossRef
30.
Lorber V, Paulus AC, Buschmann A, Schmitt B, Grupp TM, Jansson V, Utzschneider S. Elevated cytokine expression of different PEEK wear particles compared to UHMWPE in vivo. J Mater Sci Mater Med. 2014;25(1):141–9.CrossRef
31.
Langlois J, Zaoui A, Bichara DA, Nich C, Bensidhoum M, Petite H, Muratoglu OK, Hamadouche M. Biological reaction to polyethylene particles in a murine calvarial model is highly influenced by age. J Orthop Res. 2016;34(4):574–80.CrossRef
Metadata
Title
Extra-articular migration of PEEK interference screw after anterior cruciate ligament reconstruction: a report of two cases
Authors
Chao-Hua Fang
Ming Li
Yun-Feng Zhang
Hua Liu
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2021
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-021-04387-2

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