Synovitis and artificial ligaments

Sixty anterior cruciate Dacron prosthetic ligaments were placed arthroscopically in 57 patients from 1983 to 1985. Fifty-five of the 57 patients were followed for an average of 4.4 years. The complication rate at 13 months was 29%; at 4.4 years, 43%. There were 34 reoperations. In 16 knees (28%) the prosthesis had to be removed due to abrasion and arthritis with rupture of the prosthesis. Thirteen knees had chronic synovitis and one knee had bacterial infection, all of which were managed with arthroscopic debridement. Four knees required removal of the extraarticular staple. Clinical testing in 42 knees with the Dacron prosthesis still in place showed the Lysholm score improved from a preoperative score of 43 points to a score of 82 points after 5 years. Of the knees, 58% had a pivot shift of 2(+)-3+: a trace pivot shift in 30%; a negative pivot shift in only 12%. The KT-1000 arthrometer verified those pivot shifts. The results of this study are discouraging. The procedure was complicated by a high reoperation rate, usually secondary to arthritis. The impression was that although stability of the knee was improved by use of an artificial anterior cruciate ligament, the end result of the therapeutic procedure was the development of an iatrogenic model of degenerative arthritis in the human knee.