A novel, hydroxyapatite-based screw-like device for anterior cruciate ligament (ACL) reconstructions

Background: Rupture of the anterior cruciate ligament (ACL) is one of the most common injuries of the knee. Common techniques for ACL reconstruction require a graft fixation using interference screws. Nowadays, these interference screws are normally made of titanium or polymer/ceramic composites. The main challenge of application of a fixation device made entirely of bioactive ceramic is in relation to the low strength of such materials. The purpose of this study was to evaluate a novel geometry for a fixation device made of pure hydroxyapatite for ACL reconstructions that can overcome some problems of the titanium and the polymer/ceramic screws. Methods: Finite Element Analysis was used for optimization of the stress distribution in conventional interference screw geometry. For experimental evaluation of the new fixation device, ex vivo tests were performed. Results: The innovative screw-like fixation device is characterized by multiple threads with a large thread pitch. The novel design enabled the insertion of the screw into the bone without the application of an external torque or a screwdriver. In turn, it also allowed for the use of low-strength and high-bioactivity materials, like hydroxyapatite. Ex vivo tests showed that the novel screw can sustain pull-out forces up to 476 N, which is comparable to that of the commercially available BioCompositeTM interference screws (Arthrex Inc., Germany), as a reference. Conclusions: In summary, the novel screw design is a promising strategy to develop all-ceramic fixation devices for ACL reconstructions, which may eliminate some drawbacks of the current interference screws.