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Waelti SL, Fandak J, Markart S, Willems EP, Wildermuth S, Fischer T, Dietrich TJ, Matissek C, Krebs T. Prospective evaluation of ultrasound features of magnesium-based bioabsorbable screw resorption in pediatric fractures. Eur Radiol 2024; 34:1556-1566. [PMID: 37658140 DOI: 10.1007/s00330-023-10091-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/27/2023] [Accepted: 07/04/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Bioabsorbable magnesium-based alloy screws release gas upon resorption. The resulting findings in the adjacent soft tissues and joints may mimic infection. The aim of the study was to evaluate the ultrasound (US) findings in soft tissues and joints during screw resorption. METHODS Prospectively acquired US studies from pediatric patients treated with magnesium screws were evaluated for screw head visibility, posterior acoustic shadowing, twinkling artifact, foreign body granuloma, gas (soft tissue, intra-articular), alterations of the skin and subcutaneous fat, perifascial fluid, localized fluid collections, hypervascularization, and joint effusion. RESULTS Sixty-six US studies of 28 pediatric patients (nfemale = 9, nmale = 19) were included. The mean age of the patients at the time of surgery was 10.84 years; the mean time between surgery and ultrasound was 128.3 days (range = 6-468 days). The screw head and posterior acoustic shadowing were visible in 100% of the studies, twinkling artifact in 6.1%, foreign body granuloma in 92.4%, gas locules in soft tissue in 100% and intra-articular in 18.2%, hyperechogenicity of the subcutaneous fat in 90.9%, cobblestoning of the subcutaneous fat in 24.2%, loss of normal differentiation between the epidermis/dermis and the subcutaneous fat in 57.6%, localized fluid collection in 9.9%, perifascial fluid in 12.1%, hypervascularization in 27.3%, and joint effusion in 18.2%. CONCLUSION US findings in pediatric patients treated with magnesium screws strongly resemble infection, but are normal findings in the setting of screw resorption. CLINICAL RELEVANCE STATEMENT Bioabsorbable magnesium-based alloy screws release gas during resorption. The resulting US findings in the adjacent soft tissues and joints in pediatric patients may mimic infection, but are normal findings. KEY POINTS • Bioabsorbable magnesium-based alloy screws release gas upon resorption. • The resulting ultrasound findings in children's soft tissues and joints closely resemble those of soft tissue infection or osteosynthesis-associated infection. • Be familiar with these ultrasound findings in order to avoid inadvertently misdiagnosing a soft tissue infection or osteosynthesis-associated infection.
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Affiliation(s)
- Stephan L Waelti
- Department of Radiology and Nuclear Medicine, Children's Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006, St. Gallen, Switzerland.
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
| | - Jozef Fandak
- Department of Radiology and Nuclear Medicine, Children's Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006, St. Gallen, Switzerland
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Stefan Markart
- Department of Radiology and Nuclear Medicine, Children's Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006, St. Gallen, Switzerland
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Erik P Willems
- Clinical Trials Unit, Biostatistics, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Simon Wildermuth
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Tim Fischer
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Tobias J Dietrich
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Christoph Matissek
- Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Thomas Krebs
- Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
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Siroros N, Merfort R, Liu Y, Praster M, Migliorini F, Maffulli N, Michalik R, Hildebrand F, Eschweiler J. Mechanical properties of a bioabsorbable magnesium interference screw for anterior cruciate ligament reconstruction in various testing bone materials. Sci Rep 2023; 13:12342. [PMID: 37524904 PMCID: PMC10390578 DOI: 10.1038/s41598-023-39513-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023] Open
Abstract
Tears of the anterior cruciate ligament (ACL) negatively impact the stability and kinematics of the knee. Interference screws (ISs) are used for graft fixation in ACL reconstruction and provide sufficient fixation strength to withstand the patients' activities during the graft-to-bone integration process. Magnesium is a novel material used to manufacture IS given its strength and bioabsorbability. In previous studies, the selected magnesium IS design showed a better fixation performance in comparison to the conventional IS design due to its shape design and surface condition. In this study, bioabsorbable magnesium ISs were tested for their insertion (insertion torque and a number of turns to implement the IS) and fixation performance (pull-out and dynamic test). To obtain a reliable initial assessment of IS performance, ISs were implanted in 15 per cubic foot (PCF) Sawbones polyurethane foam blocks, Sawbones biomechanical tibia models with 17 PCF foam cores, and human cadaveric tibiae. Porcine tendons were used in the foam block pull-out test, and nylon ropes were used in all other test setups to prevent influences of the ligament graft material itself. In the pull-out test, the graft was subjected to tensile stress at a rate of 6 mm/min. For the dynamic test, 1000 cycles between 0 and 200 N were performed, followed by a final pull-out test. After each test, the tunnel widening pattern was observed by measuring the aspect ratio of the tunnel at the insertion site. The insertion torque lies within the normal insertion torque of the ISs as well as the average ligament tension before the insertion. In the foam block setup, the nylon rope showed a higher pull-out force than the porcine tendon. The comparison of each setup using nylon rope for both pull-out and pull-out after the dynamic test showed no significant difference between the foam block and cadaver setup. However, all tibia model setup shows unexpectedly high pull-out force due to the influence of its cortical layer. There were no statistically significant differences in tunnel widening between foam block-porcine tendon and foam block-nylon rope constructs. The pull-out resistance of magnesium ISs falls within the typical ACL tension range during daily activities. Even though the test results of the magnesium ISs are different in each bone material, the magnesium IS shows adequate fixation ability and workability during insertion without material failure.
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Affiliation(s)
- Nad Siroros
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Ricarda Merfort
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Yu Liu
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Maximilian Praster
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent, ST4 7QB, England
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London, E1 4DG, England
| | - Roman Michalik
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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Hu J, Shao J, Huang G, Zhang J, Pan S. In Vitro and In Vivo Applications of Magnesium-Enriched Biomaterials for Vascularized Osteogenesis in Bone Tissue Engineering: A Review of Literature. J Funct Biomater 2023; 14:326. [PMID: 37367290 DOI: 10.3390/jfb14060326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023] Open
Abstract
Bone is a highly vascularized tissue, and the ability of magnesium (Mg) to promote osteogenesis and angiogenesis has been widely studied. The aim of bone tissue engineering is to repair bone tissue defects and restore its normal function. Various Mg-enriched materials that can promote angiogenesis and osteogenesis have been made. Here, we introduce several types of orthopedic clinical uses of Mg; recent advances in the study of metal materials releasing Mg ions (pure Mg, Mg alloy, coated Mg, Mg-rich composite, ceramic, and hydrogel) are reviewed. Most studies suggest that Mg can enhance vascularized osteogenesis in bone defect areas. Additionally, we summarized some research on the mechanisms related to vascularized osteogenesis. In addition, the experimental strategies for the research of Mg-enriched materials in the future are put forward, in which clarifying the specific mechanism of promoting angiogenesis is the crux.
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Affiliation(s)
- Jie Hu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Jiahui Shao
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Gan Huang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Jieyuan Zhang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Shuting Pan
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
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Waelti SL, Wildermuth S, Willems EP, Fischer T, Dietrich TJ, Leschka S, Matissek C, Krebs T, Markart S. Prospective Evaluation of Magnetic Resonance Imaging Features of Magnesium-Based Alloy Screw Resorption in Pediatric Fractures. J Clin Med 2023; 12:jcm12083016. [PMID: 37109351 PMCID: PMC10141748 DOI: 10.3390/jcm12083016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The resorption of magnesium-based alloy bioabsorbable screws results in the release of hydrogen gas, which can mimic infection and enter the growth plate. The screw itself and the released gas may also affect image quality. OBJECTIVE The evaluation of magnetic resonance imaging (MRI) findings during the most active phase of screw resorption is the objective, with particular focus on the growth plate and to assess for the presence of metal-induced artifacts. MATERIAL AND METHODS In total, 30 prospectively acquired MRIs from 17 pediatric patients with fractures treated with magnesium screws were assessed for the presence and distribution of intraosseous, extraosseous, and intra-articular gas; gas within the growth plate; osteolysis along the screw; joint effusion; bone marrow edema; periosteal reaction; soft tissue edema; and metal-induced artifacts. RESULTS Gas locules were found in the bone and soft tissues in 100% of the examinations, intra-articular in 40%, and in 37% of unfused growth plates. Osteolysis and the periosteal reaction were present in 87%, bone marrow edema in 100%, soft tissue edema in 100%, and joint effusion in 50% of examinations. Pile-up artifacts were present in 100%, and geometric distortion in 0% of examinations. Fat suppression was not significantly impaired in any examination. CONCLUSIONS Gas and edema in the bone and soft tissues are normal findings during the resorption of magnesium screws and should not be misinterpreted as infection. Gas can also be detected within growth plates. MRI examinations can be performed without metal artifact reduction sequences. Standard fat suppression techniques are not significantly affected.
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Affiliation(s)
- Stephan L Waelti
- Department of Radiology and Nuclear Medicine, Children's Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Simon Wildermuth
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Erik P Willems
- Clinical Trials Unit, Biostatistics, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Tim Fischer
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Tobias J Dietrich
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Sebastian Leschka
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Christoph Matissek
- Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland
| | - Thomas Krebs
- Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland
| | - Stefan Markart
- Department of Radiology and Nuclear Medicine, Children's Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
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In Vitro Investigation of the Fixation Performance of a Bioabsorbable Magnesium ACL Interference Screw Compared to a Conventional Interference Screw. Life (Basel) 2023; 13:life13020484. [PMID: 36836841 PMCID: PMC9959181 DOI: 10.3390/life13020484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
An anterior cruciate ligament (ACL) reconstruction is a common treatment for patients with ACL rupture that aims to regain pre-injury knee stability and kinematics. During the ACL reconstruction, one method to fix the graft is the use of an interference screw (IS). The IS should provide initial stability and secure the graft during the healing period. In recent years, magnesium has emerged as an alternative material to permanent metal and polymer ISs. In addition, differences in designs, such as the shape of the IS, can influence the fixation performance of the IS. Therefore, in this biomechanical experiment, two different screw designs with two ligament materials were compared in an insertion and a pull-out test at a rate of 1 mm/s. The screw designs were a conventional polymer screw and a magnesium screw. Porcine tendon and nylon rope were used as ligament materials. All tests were performed in polyurethane foam blocks with 15 PCF density (Synbone AG, Switzerland). As a result, both screw designs required an insertion torque of less than 3 Nm. There was a significant difference between the porcine and nylon rope in pull-out tests for each screw design. The magnesium screw had the highest pull-out force at 412.14 ± 50.00 N for porcine tendon and 707.38 ± 21.81 N for nylon rope. There were no significant differences in tunnel widening (narrow-wide ratio) between each ligament material. The magnesium screw showed the lowest narrow-wide tunnel ratio, implying a better ability to compress the graft to the tunnel. In conclusion, a more optimized magnesium IS design resulted in better graft fixation and an improved ACL reconstruction outcome.
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Sonnow L, Ziegler A, Pöhler GH, Kirschner MH, Richter M, Cetin M, Unal M, Kose O. Alterations in magnetic resonance imaging characteristics of bioabsorbable magnesium screws over time in humans: a retrospective single center study. Innov Surg Sci 2021; 6:105-113. [PMID: 35224178 PMCID: PMC8826160 DOI: 10.1515/iss-2021-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives This study aimed to examine the alterations in magnetic resonance imaging (MRI) characteristics of bioabsorbable magnesium (Mg) screws over time in a single center study in humans. Methods Seventeen patients who underwent medial malleolar (MM) fracture or osteotomy fixation using bioabsorbable Mg screws and had at least one postoperative MRI were included in this retrospective study. Six of them had more than one MRI in the postoperative period and were subject of the artifact reduction measurements. 1.5T or 3T MRI scans were acquired in different periods in each patient. The size and extent of the artifact were assessed independently by two experienced radiologists both quantitatively (distance measurement) and qualitatively (Likert scale). Results In the quantitative measurements of the six follow-up patients the screw’s signal loss artifact extent significantly decreased over the time, regardless of the MRI field strength (p<0.001). The mean artifact reduction was 0.06 mm (95% confidence interval [CI]: 0.05–0.07) for proton density weighted [PDw] and 0.04 mm (95% CI: 0.03–0.05) for T1 weighted (T1w) sequences per week. The qualitative assessments similarly showed significant artifact reduction in all MRI sequences. Different imaging findings, like bone marrow edema (BME), liquid collections, and gas formation were reported. The overall inter-reader agreement was high (κ=0.88, p<0.001). Conclusions The time-dependent artifact reduction of Mg screws in postoperative controls might indicate the expected self-degradation of the Mg implants. In addition, different MRI findings were reported, which are characteristic of Mg implants. Further MRI studies are required to get a better understanding of Mg imaging properties.
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Affiliation(s)
- Lena Sonnow
- Department of Diagnostic and Interventional Radiology , Hannover Medical School , Hannover , Germany
| | - Andreas Ziegler
- Medizincampus Davos , Davos , Switzerland
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal , Pietermaritzburg , South Africa
- Department of Cardiology , University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Gesa H. Pöhler
- Department of Diagnostic and Interventional Radiology , Hannover Medical School , Hannover , Germany
| | | | | | - Mustafa Cetin
- Department of Radiology , Antalya Education and Research Hospital , Antalya , Turkey
| | - Melih Unal
- Department of Orthopedics and Traumatology , Antalya Education and Research Hospital , Antalya , Turkey
| | - Ozkan Kose
- Department of Orthopedics and Traumatology , Antalya Education and Research Hospital , Antalya , Turkey
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7
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Plaass C, von Falck C, Ettinger S, Sonnow L, Calderone F, Weizbauer A, Reifenrath J, Claassen L, Waizy H, Daniilidis K, Stukenborg-Colsman C, Windhagen H. Bioabsorbable magnesium versus standard titanium compression screws for fixation of distal metatarsal osteotomies - 3 year results of a randomized clinical trial. J Orthop Sci 2018; 23:321-327. [PMID: 29174422 DOI: 10.1016/j.jos.2017.11.005] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 10/05/2017] [Accepted: 11/07/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND For the treatment of hallux valgus commonly distal metatarsal osteotomies are performed. Persistent problems due to the hardware and the necessity of hardware removal has led to the development of absorbable implants. To overcome the limitations of formerly used materials for biodegradable implants, recently magnesium has been introduced as a novel implant material. This is the first study showing mid-term clinical and radiological (MRI) data after using magnesium implants for fixation of distal metatarsal osteotomies. MATERIAL AND METHODS 26 patients with symptomatic hallux valgus were included in the study. They were randomly selected to be treated with a magnesium or standard titanium screw for fixation of a modified distal metatarsal osteotomy. The patients had a standardized clinical follow up and MRI investigation 3 years' post-surgery. The clinical tests included the range of motion of the MTP 1, the AOFAS, FAAM and SF-36 scores. Further on the pain was evaluated on a VAS. RESULTS Eight patients of the magnesium group and 6 of the titanium group had a full clinical and MRI follow up 3 years postoperatively. One patient was lost to follow-up. All other patients could be interviewed, but denied full study participation. There was a significant improvement for all tested clinical scores (AOFAS, SF-36, FAAM, Pain-NRS) from pre-to postoperative investigation, but no statistically relevant difference between the groups. Magnesium implants showed significantly less artifacts in the MRI, no implant related cysts were found and the implant was under degradation three years postoperatively. CONCLUSION In this study, bioabsorbable magnesium implants showed comparable clinical results to titanium standard implants 3 years after distal modified metatarsal osteotomy and were more suitable for radiologic analysis. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Christian Plaass
- Orthopedic Clinic in Diakovere Annastift, Hannover Medical School, Anna-von-Borries Strasse 1-7, 30625 Hannover, Germany.
| | - Christian von Falck
- Institute for Radiology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Sarah Ettinger
- Orthopedic Clinic in Diakovere Annastift, Hannover Medical School, Anna-von-Borries Strasse 1-7, 30625 Hannover, Germany
| | - Lena Sonnow
- Institute for Radiology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Franco Calderone
- Radiological Practice, Schwarzer Baer, Anna-von-Borries Strasse 1-7, 30625 Hannover, Germany
| | - Andreas Weizbauer
- CrossBIT, Centre for Biocompatibility and Implant-Immunology, Department of Orthopedic Surgery, Hannover Medical School, Feodor-Lynen-Straße 31, 30625, Hannover, Germany
| | - Janin Reifenrath
- CrossBIT, Centre for Biocompatibility and Implant-Immunology, Department of Orthopedic Surgery, Hannover Medical School, Feodor-Lynen-Straße 31, 30625, Hannover, Germany
| | - Leif Claassen
- Orthopedic Clinic in Diakovere Annastift, Hannover Medical School, Anna-von-Borries Strasse 1-7, 30625 Hannover, Germany
| | - Hazibullah Waizy
- Clinic for Foot and Ankle Surgery, Hessing Foundation, Augsburg, Germany
| | - Kiriakos Daniilidis
- Orthopedic Clinic in Diakovere Annastift, Hannover Medical School, Anna-von-Borries Strasse 1-7, 30625 Hannover, Germany
| | - Christina Stukenborg-Colsman
- Orthopedic Clinic in Diakovere Annastift, Hannover Medical School, Anna-von-Borries Strasse 1-7, 30625 Hannover, Germany
| | - Henning Windhagen
- Orthopedic Clinic in Diakovere Annastift, Hannover Medical School, Anna-von-Borries Strasse 1-7, 30625 Hannover, Germany
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Kuśnierczyk K, Basista M. Recent advances in research on magnesium alloys and magnesium–calcium phosphate composites as biodegradable implant materials. J Biomater Appl 2016; 31:878-900. [DOI: 10.1177/0885328216657271] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Magnesium alloys are modern biocompatible materials suitable for orthopaedic implants due to their biodegradability in biological environment. Many studies indicate that there is a high demand to design magnesium alloys with controllable in vivo corrosion rates and required mechanical properties. A solution to this challenge can be sought in the development of metal matrix composites based on magnesium alloys with addition of relevant alloying elements and bioceramic particles. In this study, the corrosion mechanisms along with corrosion protection methods in magnesium alloys are discussed. The recently developed magnesium alloys for biomedical applications are reviewed. Special attention is given to the newest research results in metal matrix composites composed of magnesium alloy matrix and calcium phosphates, especially hydroxyapatite or tricalcium phosphate, as the second phase with emphasis on the biodegradation behavior, microstructure and mechanical properties in view of potential application of these materials in bone implants.
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Affiliation(s)
- Katarzyna Kuśnierczyk
- Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Poland
| | - Michał Basista
- Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Poland
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9
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Cheng P, Han P, Zhao C, Zhang S, Zhang X, Chai Y. Magnesium inference screw supports early graft incorporation with inhibition of graft degradation in anterior cruciate ligament reconstruction. Sci Rep 2016; 6:26434. [PMID: 27210585 PMCID: PMC4876376 DOI: 10.1038/srep26434] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/03/2016] [Indexed: 11/09/2022] Open
Abstract
Patients after anterior cruciate ligament (ACL) reconstruction surgery commonly encounters graft failure in the initial phase of rehabilitation. The inhibition of graft degradation is crucial for the successful reconstruction of the ACL. Here, we used biodegradable high-purity magnesium (HP Mg) screws in the rabbit model of ACL reconstruction with titanium (Ti) screws as a control and analyzed the graft degradation and screw corrosion using direct pull-out tests, microCT scanning, and histological and immunohistochemical staining. The most noteworthy finding was that tendon graft fixed by HP Mg screws exhibited biomechanical properties substantially superior to that by Ti screws and the relative area of collagen fiber at the tendon-bone interface was much larger in the Mg group, when severe graft degradation was identified in the histological analysis at 3 weeks. Semi-quantitative immunohistochemical results further elucidated that the MMP-13 expression significantly decreased surrounding HP Mg screws with relatively higher Collagen II expression. And HP Mg screws exhibited uniform corrosion behavior without displacement or loosening in the femoral tunnel. Therefore, our results demonstrated that Mg screw inhibited graft degradation and improved biomechanical properties of tendon graft during the early phase of graft healing and highlighted its potential in ACL reconstruction.
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Affiliation(s)
- Pengfei Cheng
- Department of Orthopaedic, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Pei Han
- Department of Orthopaedic, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Changli Zhao
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Shaoxiang Zhang
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
- Suzhou Origin Medical Technology Co. Ltd., Suzhou 215513, China
| | - Xiaonong Zhang
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
- Suzhou Origin Medical Technology Co. Ltd., Suzhou 215513, China
| | - Yimin Chai
- Department of Orthopaedic, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
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Examination of a biodegradable magnesium screw for the reconstruction of the anterior cruciate ligament: A pilot in vivo study in rabbits. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 59:1100-1109. [PMID: 26652469 DOI: 10.1016/j.msec.2015.11.037] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/28/2015] [Accepted: 11/13/2015] [Indexed: 11/24/2022]
Abstract
The reconstruction of the anterior cruciate ligament is, for the most part, currently performed with interference screws made of titanium or degradable polymers. The aim of this study was to investigate the use of biodegradable magnesium interference screws for such a procedure because of their known biocompatibility and reported osteoconductive effects. The left tibiae of each of 18 rabbits were implanted with a magnesium-based (MgYREZr-alloy) screw, and another 18 with a titanium-based control. Each group was divided into observation periods of 4, 12 and 24weeks. After sacrifice, μCT scans were acquired to assess the amount of the gas liberated and the degradation rate of the implant. Histological evaluations were performed to investigate the local tissue response adjacent to the implant and to assess the status of the attachment between the tendon and the bone tissue. The μCT scans showed that liberation of gas was most prominent 4weeks after implantation and was significantly decreased by 24weeks. All screws remained in situ and formed a sufficient connection with the tendon and sufficient osseous integration at 24weeks. Histological evaluations showed neither inflammatory reactions nor necrosis of the tendon. The results of this pilot study in rabbits indicate that this magnesium-based interference screw should be considered as an alternative to conventional implant materials.
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Reifenrath J, Marten AK, Angrisani N, Eifler R, Weizbauer A. In vitro
and
in vivo
corrosion of the novel magnesium alloy Mg–La–Nd–Zr: influence of the measurement technique and
in vivo
implant location. Biomed Mater 2015; 10:045021. [DOI: 10.1088/1748-6041/10/4/045021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Martinez Sanchez AH, Luthringer BJC, Feyerabend F, Willumeit R. Mg and Mg alloys: how comparable are in vitro and in vivo corrosion rates? A review. Acta Biomater 2015; 13:16-31. [PMID: 25484334 DOI: 10.1016/j.actbio.2014.11.048] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 11/18/2014] [Accepted: 11/25/2014] [Indexed: 01/20/2023]
Abstract
Due to their biodegradability, magnesium and magnesium-based alloys could represent the third generation of biomaterials. However, their mechanical properties and time of degradation have to match the needs of applications. Several approaches, such as choice of alloying elements or tailored microstructure, are employed to tailor corrosion behaviour. Due to the high electrochemical activity of Mg, numerous environmental factors (e.g. temperature and surrounding ion composition) influence its corrosion behaviour, making it unpredictable. Nevertheless, the need of reliable in vitro model(s) to predict in vivo implant degradation is increasing. In an attempt to find a correlation between in vitro and vivo corrosion rates, this review presents a systematic literature survey, as well as an attempt to correlate the different results.
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Affiliation(s)
- Adela Helvia Martinez Sanchez
- Institute of Materials Research, Department for Structural Research on Macromolecules, Helmholtz-Zentrum Geesthacht (HZG), Geesthacht, Germany.
| | - Bérengère J C Luthringer
- Institute of Materials Research, Department for Structural Research on Macromolecules, Helmholtz-Zentrum Geesthacht (HZG), Geesthacht, Germany
| | - Frank Feyerabend
- Institute of Materials Research, Department for Structural Research on Macromolecules, Helmholtz-Zentrum Geesthacht (HZG), Geesthacht, Germany
| | - Regine Willumeit
- Institute of Materials Research, Department for Structural Research on Macromolecules, Helmholtz-Zentrum Geesthacht (HZG), Geesthacht, Germany
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