Prosthetic Anterior Cruciate Ligament Repairs: Current Status

摘要

Research continues to find an appropriate material for use as a replacement for injured ligaments, especially those in and around the shoulder, knee, and ankle. We have pursued a solution to define the optimum management of ligament injuries commonly observed in military personnel, especially the anterior cruciate ligament. The first study involved primary repairs of lacerated anterior cruciate ligaments, but the results were disappointing. When the lacerated ligaments were augmented with the medial one-third of the patellar tendon, all healed and the joints were stable. In an attempt to find a suitable prosthetic material that would allow us to avoid use of autogenous tissue grafts, a biodegradable ligament made of 100% polyglycolic acid (PGA) was evaluated. That material had acceptable biomechanical and physical properties, but it resorbed too rapidly. Evaluation of the PGA blended with woven dacron is underway in an effort to prolong residual strength and provide for fibrous tissue ingrowth. Other investigators are examining materials which are fully biodegradable, biodegradable and replaced, partially biodegradable, or permanent. The goals for any prosthetic ligament demand that it be biologically compatible, easy to insert surgically, mechanically function as a normal ligament, and provide a satisfactory scaffold for fibrous tissue ingrowth.