title: A combined intra- and extra-articular reconstruction using a carbon-dacron composite prosthesis for chronic anterior cruciate instability. A two to six-year follow-up study.
abstract: Fifty patients with chronic symptomatic anterior cruciate insufficiency underwent ligamentous reconstruction using the "Westminster Composite Prosthesis" which consists of a central core of carbon fibre with an external weave of polyester. In 42 patients, the prosthesis was used as an augmentation within a tube of ilio-tibial tract, combined with a MacIntosh's extraarticular reconstruction. The prosthetic replacement alone was used in eight patients where there had been a previous extraarticular reconstruction and was associated with only fair results. The average age of the patients at operation was 28.5 years (range 18 to 50 years); instability of the knee had been present for a mean of 5.3 years and the average follow-up was 3.8 years (range 2 to 6 years). Assessment included subjective functional rating (Lysholm knee score) and clinical examination for instability. Thirty-seven patients (74%) had a good or excellent result, 11 (22%) had a fair result and two (4%) had a poor result. The Lachman test was grade I or less in 35 patients and the pivot shift sign was eliminated in 37 patients. Clinical signs of instability correlated well with the Lysholm knee score (p less than 0.001). Twenty-two unselected patients (44%) underwent an arthroscopic assessment and biopsy of the "neoligament" at an average of 10.4 months post-operatively. The prosthesis was found to be stable and well covered by a thick fibrous sheath ("neoligament") in 19 patients. The prosthesis was partially ruptured in two patients and completely disrupted in one. Thirty-two patients (64%) returned to their previous sports and 13 of them (26%) achieved their pre-injury level of performance.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Orthopaedics, Westminster Hospital, London, United Kingdom.
authors.forename: P M
authors.initials: PM
authors.lastname: Aichroth
authors.forename: D V
authors.initials: DV
authors.lastname: Patel
authors.forename: C B
authors.initials: CB
authors.lastname: Jones
authors.forename: J S
authors.initials: JS
authors.lastname: Wand
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000473:pathology / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy; D002244:Carbon; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000473:pathology / Q000601:surgery; D008297:Male; D008722:Methods; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D011182:Postoperative Care; D011183:Postoperative Complications; D019736:Prostheses and Implants; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012421:Rupture
chemical_list: D011093:Polyethylene Terephthalates; D002244:Carbon