Estudo comparativo do alargamento dos tneis na

reconstruo do LCA: absorvvel nacional versus PEEK

Introduo:
Entre os diversos mtodos de fixao do enxerto utilizados hoje na reconstruo do LCA est o parafuso
de interferncia bioabsorvvel. Este mtodo citado por vrios autores como vantajoso em comparao com o mesmo mtodo
em material metlico, sendo igualmente resistente ao arrancamento ou at superior. Entre as vantagens estariam a facilidade
de eventual reviso, no interferncia em exames de imagem e menor lacerao do enxerto durante sua insero, alm do
aspecto biolgico da fixao, onde o parafuso absorvvel facilitaria a passagem da zona de transio para zona de
fibrocartilagem calcificada e finalmente tecido sseo.
Os contrrios ao parafuso absorvvel se baseiam em um eventual alargamento do tnel, causado por uma
reao de ostelise estimulada pelo cido ltico (matria prima do parafuso absorvvel). Porm alguns autores observam o
mesmo alargamento com outros mtodos de fixao, inclusive aqueles que no ocupam o espao intra-tnel, como o
endobutton ou parafuso em poste, e outros comprovam que mesmo com o alargamento no h qualquer influncia no
resultado clnico da cirurgia, como instabilidade clnica subjetiva ou objetiva.
Objetivo:
Avaliao preliminar do resultado clnico e do alargamento dos tneis na reconstruo do LCA com parafusos de interferncia em
PEEK e bioabsorvvel (PLDL) de fabricante nacional (Sintegra Surgical Sciencies).
Materiais e Mtodos:
Foram selecionados 2 grupos de 20 pacientes consecutivos submetidos a reconstruo do LCA (sem
outros ligamentos associados) com a utilizao de parafusos em PEEK (poli-ter-etil-Ketona) ou PLDL (cido poli-lctico)
alocados aleatoriamente e de acordo com a autorizao do convenio e concordncia do paciente. At o momento foram
reconstrudos e inclusos no trabalho 18 ligamentos utilizando PLDL e 12 PEEK. Com 6 meses de ps operatrio foi realizado RX
digital na posio Antero posterior (AP) e perfil (P) em tamanho real (aferido com moeda) e realizado a medida dos tneis
femorais e tibiais nas duas incidncias na reas de esclerose e comparados com o tamanho inicial do dimetro do parafuso
utilizado .
Resultados:
Nos ligamentos fixados com parafusos em PEEK, a mdia de alargamento do tnel tibial, nas incidncias AP e P foi de 2,42mm ou
27,9% e para o tnel femoral a mdia de alargamento nas duas incidncias foi de 4,3mm ou 49,65%.
Nos ligamentos fixados com parafusos em PLDL, a mdia de alargamento do tnel tibial nas incidncias AP e P foi de 3,25mm ou
38,8% e para o tnel femoral a mdia de alargamento nas duas incidncias foi de 4,52mm ou 54,06%.
Os dados foram analisados utilizando-se o teste de Student, com IC 95%, p=0,05, onde no houve diferena estatisticamente
significativa.
Todos os pacientes operados foram questionados sobre intercorrncias ou queixas clnicas, como queixas de falseio ou
instabilidade, e nenhum problema foi relatado. Testes de avaliao objetiva (IKDC) sero aplicados posteriormente.

60,00%

50,00%

40,00%

PEEK

30,00%

PLDL Sinfix
20,00%
PLDL Sinfix

10,00%

0,00%
PEEK
Alargamento Tibial
Alargamento Femoral

Discusso e Concluso:
O alargamento inicial (6meses) dos parafusos de interferncia bioabsorvvel (PLDL) nacional foi
semelhante e sem diferena significativa em comparao com os parafusos de PEEK, o qual possui caracterstica bioinerte, ou
seja, no h absoro nem reao inflamatria, no apresentando qualquer complicao em ralao ao parafuso ou diferena
no resultado clinico.
Os nmeros do alargamento deste estudo ainda so compatveis com a literatura, que mostra de 33 a
74% de alargamento com tendes flexores, inclusive aqueles fixados com mtodos que no tm material intra-tnel.
Os parafusos de interferncia em PLDL nacional se mostraram seguros e com os resultados semelhantes
ao parafusos de PEEK na avaliao inicial com 6 meses.
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