Can We Jump Out of the Periodic Circles of Hope and Disappointment in the Anterior Cruciate Ligament Reconstruction Using Synthetic Ligament? A Nationwide Multicenter Study by the China Artificial Ligament Study Group (CALSG)

Abstract

Background: The application of synthetic ligaments for theanterior cruciate ligament (ACL) reconstruction was never untroubled. Their history was commented as Periodic cycles of hope and disappointment. Currently, their long-term clinical outcome was still controversial despite satisfactory short and mid-term results. If we want to spare us from another disappointment, we have to clarify the long-term rate of adverse events and the fundamental reason for failure. Methods: The national multicenter research was backed by the China Artificial Ligament Study Group (CALSG). The ACL reconstruction using synthetic ligaments between July 2004 and December 2010 were screened. The adverse events consisted of cumulative failure and complications. For failure cases, the symptoms, the clinical outcomes, the reason for failure, and the activity level were investigated. Findings: A total of 1705 cases from 20 centers were screened with 1393 cases included. And 1146 cases fulfilled evaluation at meanly 87 months postoperative. Adverse events were confirmed in 83 cases with the rate of 7.2% (83/1146). Among them, the cumulative failure was confirmed in 36 cases; complications in 32 cases; cumulative failure combined with complications in 15 cases. Generally, the cumulative failure rate was 4.5% (51/1146), and the complication rate was 4.1% (47/1146). For failure cases, the bone tunnel position was evaluated in 49 of them. The bone tunnel malposition, an error caused by the surgeon, was confirmed in 32 cases with the constituent ratio of 65.3% (32/49); trauma in 25 cases with the constituent ratio of 49.0% (25/51); screw loosening in 8 cases with the constituent ratio of 15.7% (8/51). Conclusion: Currently, the failure rate of ACL reconstruction using synthetic ligament was 4.5% at meanly 87 months postoperative. Bone tunnel malposition was the primary cause of failure. We need to pay attention to the technique error when ACL reconstruction using synthetic ligaments failed, instead of merely blaming the graft. Funding Statement: China Artificial Ligament Study Group Declaration of Interests: The authors state no conflict reported. Ethics Approval Statement: KY2017-334 (Huashan Hospital Institutional Review Board)