Work

Biointegrative Fixation for Tibial Tubercle Osteotomy Is Effective and May Lower Removal Rate

Year: 2025

Type: article

Abstract: Purpose To report the safety and efficacy of biointegrative fiber‐reinforced implants for tibial tubercle osteotomy (TTO) and perform a cost‐benefit analysis. Methods Patients treated with TTO for all indications by a single surgeon from May 2017 to July 2024 were retrospectively reviewed. There were no exclusion criteria. In 2023, the surgeon switched TTO fixation from two 4.5‐mm metal compression screws to 2 biointegrative, partially threaded 4.0‐mm headless compression screws, made of continuous mineral fibers comprised of elements found in natural bone (SiO 2 , Na 2 O, CaO, MgO, B 2 O 3 , and P 2 O 5 ), and bound together by PLDLA [poly (L‐lactide‐co‐D,L‐lactide)] (70:30 L:DL) in 50% weight by weight ratio. Postoperative protocols were consistent across fixation types, with full weight‐bearing as tolerated in full extension for 6 weeks and range of motion from 0 to 90° allowed immediately. Patients were followed longitudinally for osseous union, recurrent instability, and return to the operating room. Results Sixty‐two TTOs were analyzed (44 metal, 18 biointegrative); 61.3% of patients were female, and the median age was 23.3 years (interquartile range 22.5). One patient with biointegrative implants underwent irrigation and debridement with implant retention at 9 days postoperatively. Mean follow‐up for biointegrative fixation was 1.3 ± 0.4 years (range: 0.5‐1.8) and for metal fixation was 3.5 ± 1.8 years (range: 0.4‐6.7), P < .001. All patients achieved clinical union by 6 months without differences in time to clinical union ( P = .159). Hardware removal rates differed between metal versus biointegrative groups (29.5 vs 0%, P = .009) but otherwise did not differ for rates of superficial infection (2.3 vs 0%, P = .519) or deep infection (2.3 vs 5.6%, P = .507). Conclusions Biointegrative screws are a safe and effective alternative to metal screws for TTO in short‐term follow‐up. The use of biointegrative fixation may reduce the need for secondary hardware removal procedures commonly reported with 4.5‐mm metal screws, albeit at a potentially increased cost to the health system. Level of Evidence Level III, retrospective comparative study.

Source: Arthroscopy Sports Medicine and Rehabilitation

DOI: 10.1016/j.asmr.2025.101267