Long-term clinical review (10-20 years) after reconstruction of the anterior cruciate ligament using the Leeds-Keio synthetic ligament.

Prosthetic ligament use for anterior cruciate ligament (ACL) reconstruction was popular in the 1980s and 1990s. Information from published studies regarding the long-term outcomes of this surgery is limited. This paper presents the long-term results of stabilization of the ACL deficient knee using the Leeds-Keio synthetic ligament formed from woven polyester. Fifty patients were seen in clinic at a mean follow-up of 11.9 years (range 8.7-19.7 years). The mean ages were: at injury 26.8 years (range 16-47 years), at surgery 29.9 years (range 18-47 years), and at review 42 years (30-56 years). Of the 50 patients included, 86% were male and 14% were female. The main causes of injury were football (42%), rugby (25%), and skiing (8%). The mean time from injury to surgery was 37.6 months (range 0-324 months). All patients received intra-articular (IA) ligaments placed in the anatomical position of the natural ACL. In addition, approximately 75% also had an extra-articular ligament placed so that it ran parallel to the IA component on the lateral aspect of the knee. At review, patients were thoroughly assessed with history, examination, and IKDC criteria. IKDC scores were excellent or good in 92% of patients seen while combined IKDC and thorough clinical history findings were good or excellent in 84% of patients seen. Patient satisfaction was high with 90% of patients being satisfied or very satisfied with the outcome of surgery. Activity levels were also high according to IKDC criteria. At one year postoperatively, approximately 66% of patients had returned to their preinjury level of activity. At review, almost half of all patients still maintained this level. Of those patients who did not, only 6% attributed this to knee instability. Furthermore, the vast majority of patients (92%) still had activity levels superior to that of postinjury/preoperatively. Rupture of the intra-articular component was confirmed in six cases (12%) and three of these patients continued to experience functional knee instability. These results demonstrate that synthetic ligament can provide long-term functional stability in the knee following a loss of the ACL.