{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T00:08:15Z","timestamp":1793059695630,"version":"4.5.0"},"reference-count":23,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:00:00Z","timestamp":1758585600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:00:00Z","timestamp":1758585600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:00:00Z","timestamp":1758585600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:00:00Z","timestamp":1758585600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,9,14]],"date-time":"2025-09-14T00:00:00Z","timestamp":1757808000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["arthroscopysportsmedicineandrehabilitation.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy, Sports Medicine, and Rehabil."],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To report the safety and efficacy of biointegrative fiber\u2010reinforced implants for tibial tubercle osteotomy (TTO) and perform a cost\u2010benefit analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      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\u2010mm metal compression screws to 2 biointegrative, partially threaded 4.0\u2010mm headless compression screws, made of continuous mineral fibers comprised of elements found in natural bone (SiO\n                      <jats:sub>2<\/jats:sub>\n                      , Na\n                      <jats:sub>2<\/jats:sub>\n                      O, CaO, MgO, B\n                      <jats:sub>2<\/jats:sub>\n                      O\n                      <jats:sub>3<\/jats:sub>\n                      , and P\n                      <jats:sub>2<\/jats:sub>\n                      O\n                      <jats:sub>5<\/jats:sub>\n                      ), and bound together by PLDLA [poly (L\u2010lactide\u2010co\u2010D,L\u2010lactide)] (70:30 L:DL) in 50% weight by weight ratio. Postoperative protocols were consistent across fixation types, with full weight\u2010bearing as tolerated in full extension for 6 weeks and range of motion from 0 to 90\u00b0 allowed immediately. Patients were followed longitudinally for osseous union, recurrent instability, and return to the operating room.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixty\u2010two 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\u2010up for biointegrative fixation was 1.3 \u00b1 0.4 years (range: 0.5\u20101.8) and for metal fixation was 3.5 \u00b1 1.8 years (range: 0.4\u20106.7),\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001. All patients achieved clinical union by 6 months without differences in time to clinical union (\n                      <jats:italic>P<\/jats:italic>\n                      = .159). Hardware removal rates differed between metal versus biointegrative groups (29.5 vs 0%,\n                      <jats:italic>P<\/jats:italic>\n                      = .009) but otherwise did not differ for rates of superficial infection (2.3 vs 0%,\n                      <jats:italic>P<\/jats:italic>\n                      = .519) or deep infection (2.3 vs 5.6%,\n                      <jats:italic>P<\/jats:italic>\n                      = .507).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Biointegrative screws are a safe and effective alternative to metal screws for TTO in short\u2010term follow\u2010up. The use of biointegrative fixation may reduce the need for secondary hardware removal procedures commonly reported with 4.5\u2010mm metal screws, albeit at a potentially increased cost to the health system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, retrospective comparative study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.asmr.2025.101267","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T10:31:35Z","timestamp":1758709895000},"update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":1,"title":["Biointegrative Fixation for Tibial Tubercle Osteotomy Is Effective and May Lower Removal Rate"],"prefix":"10.1002","volume":"7","author":[{"given":"Scott M.","family":"Feeley","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Walter Reed National Military Medical Center Bethesda Maryland U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rehan","family":"Dawood","sequence":"additional","affiliation":[{"name":"Inova Sports Medicine Fairfax Virginia U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parth","family":"Sharma","sequence":"additional","affiliation":[{"name":"Inova Sports Medicine Fairfax Virginia U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie M.","family":"Mwendwa","sequence":"additional","affiliation":[{"name":"Villanova University Villanova Pennsylvania U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M.","family":"Kuenze","sequence":"additional","affiliation":[{"name":"Department of Kinesiology University of Virginia Charlottesville Virginia U.S.A."},{"name":"School of Medicine University of Virginia Inova Campus Falls Church Virginia U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward S.","family":"Chang","sequence":"additional","affiliation":[{"name":"Inova Sports Medicine Fairfax Virginia U.S.A."},{"name":"School of Medicine University of Virginia Inova Campus Falls Church Virginia U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon J.","family":"Bryant","sequence":"additional","affiliation":[{"name":"Inova Sports Medicine Fairfax Virginia 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