Authors' objectives:

The objective of the report was to assess the available evidence on the usefulness of synthetic grafts (artificial ligaments) in knee anterior cruciate ligament reconstruction.

Authors' results and conclusions: Only three randomized clinical trials with very few patients were found. Most evidence comes from case series reports. Gore-tex artificial ligament: Two case series reports and one randomized study versus Kennedy autologous ligament, with a total of 195 analyzed knees were found. The results with the Gore-Tex ligament were, in general, poor. The three studies show high rates of pain and knee joint effusion, low motility scores and high rates of graft loss, around 50% at 5 years. Dacron artificial ligament: Six case series reports were found with a total of 115 patients. The rates of graft failure were high (25% at 21 months and 37% at 50 months), although motility scores were initially good. LARS artificial ligament: One randomized clinical trial versus patellar tendon and one case series report were found. The randomized clinical trial compared ACL reconstruction in patients with chronic instability using autologous patellar tendon in 27 patients and LARS in 26. There were no differences in the rate of failure between the groups (two knees in the LARS group an one in the patellar group) at 24 months. No differences were observed in the increase in activity throughout follow-up. Results using the Knee and Osteoarthritis Outcome Score (KOOS) were higher in the LARS group during the first year of follow-up, mainly in the fields related to sports and recreation (p= 0.04) and quality of life (p= 0.02), but there were no differences as regards the patellar group in any of the fields at 24 months. Ligament laxity was higher in the LARS group at 6 months (p= 0.01), but similar to that of the patellar group at 24 months. The case series report which included 47 patients with a median follow-up of 19 months shows good scores in the osteoarthritis questionnaire. The motility score was significantly higher after surgery, but lower than that before injury. 8.5% of the patients required a new surgical intervention. Leeds Keio artificial ligament: One randomized clinical trial versus patellar tendon and four case series reports were found. The randomized trial included 60 patients with chronic unilateral ACL rupture, with autologous patellar tendon reconstruction (26 patients) or Leeds-Keio artificial ligament (29 patients). The mean follow-up was 28 months. Results favored the autologous tendon, with significantly lower knee instability (4% vs. 48%) and a higher number of patients with a degree of motion considered excellent (27% vs. 10%). The four case series reports with a total of 207 patients reported total rates of failure of around 15-17% at 5 years, rates of ligament rupture of 28% and ligament laxity of 56% at 13 years. Leeds Keio II artificial ligament: Only one case series report published this year was found which reported the follow-up of 13 patients for at least 12 months who did not develop significant complications.

Authors' recommendations: Few trials of poor methodological quality and a limited number of patients for all the synthetic ligament prostheses in reconstructive ACL surgery were found. The studies found are generally case series reports presenting worse results than those observed with autologous patellar or semitendinosus tendons. Although results reported with LARS are promising, there is still no long term evidence available. In spite of the potential advantages of synthetic ligaments, the available evidence does not allow recommendation of this procedure.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.iecs.org.ar/

Year Published: 2006

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)