SharkScrew ACL RCT

This prospective, randomized controlled trial will compare three tibial interference screw types used for graft fixation during primary anterior cruciate ligament (ACL) reconstruction: a polyetheretherketone (PEEK) screw, a biocomposite screw, and an allograft bone screw. Although interference screws are widely used for tibial fixation, the optimal screw material remains uncertain, particularly regarding its effect on tibial tunnel widening and graft incorporation.

Adult patients undergoing primary ACL reconstruction with a quadriceps tendon autograft using a standardized surgical technique will be randomly assigned to one of the three tibial fixation methods. The primary outcome is tibial tunnel widening measured by computed tomography (CT) 12 months after surgery. Secondary outcomes include graft integration assessed by magnetic resonance imaging (MRI) and patient-reported clinical outcomes, including the Lysholm, Tegner, KOOS, and ACL-Return to Sport after Injury (ACL-RSI) scores, collected during routine follow-up. The study aims to determine whether allograft bone screws reduce tunnel widening and improve graft integration compared with PEEK and biocomposite screws while maintaining comparable clinical outcomes.