Gore-Tex prosthetic ligament in anterior cruciate deficient knees

Abstract

Reconstruction for symptomatic anterior cruciate defi cient knees has yielded varying success rates. Pros thetic cruciate replacement has recently become a po tentially attractive alternative. The results of the Gore- Tex polytetrafluoroethylene ligament, which is intended as a permanent replacement, are reported.

Eighty-two patients were followed prospectively, mean age was 28 years (range, 16 to 51 years) and mean followup was 18 months (range, 12 to 30 months). Subjective scores improved in all categories, including pain, swelling, giving way, locking, and stair climbing. All patients without complications had no episodes of actual giving way, considered themselves improved, and returned to activities of daily living at 3 weeks and athletics at 8 months. Range of motion lacking at 3 months was 2° of extension and 10° of flexion, and at 12 months was 0° of extension and 4° of flexion. All mean objective data, including the anterior drawer, Lachman, and pivot shift, demonstrated im provement at final followup. Cybex testing revealed improvement in relative quadriceps strength from 88% to 99%. The KT-1000 Arthrometer showed improve ment in the injured-normal knee difference score throughout the follow-up period.

Of importance is that while final objective data was improved over initial data, an early nonprogressive shift toward loosening was indicated by worsening of the drawer, Lachman, pivot shift, and KT-1000 scores. This shift may be attributed to resorption of interposed soft tissue, creep, or loosening of the graft. Subjective scores remained stable after improving.

Complications included four ruptures, four chronic sterile effusions with partial attenuation, one infection, and one symptomatic loose body. There were 14 re- operations (17%), a total of 15 complications (18%), and 7 permanent complications (8%). There were no deaths, pulmonary emboli, or medical complications.

We feel that the Gore-Tex ligament may become a rational alternative for anterior cruciate reconstruction in selected cases of prior reconstructive failure or older, less active individuals with symptomatic instability. Sur gical dissection is minimal, with maintenance of autog enous tissues yielding rapid recovery and low morbidity. The results presented are based upon preliminary data, and indications for expanded use of the ligament and definitive conclusions regarding the natural history of the graft will have to await further long-term followup.