Skip to main navigation menu Skip to main content Skip to site footer

Narrative Review

Vol. 11 No. 1 (2008)

Anterior cruciate ligament reconstruction: a look at prosthetics - past, present and possible future

  • Randy Mascarenhas
  • Peter B. MacDonald
October 29, 2020


ABSTRACT: Biological tissue autograft reconstruction using the patellar tendon or quadrupled semitendinosus/gracilis tendons has become the most popular procedure in surgical treatment of a ruptured ACL. This article provides a review of the history of the use of prosthetics with respect to ACL reconstruction grafts including Carbon Fibre, Gore-Tex and Dacron prosthetics as well as the Leeds-Keio Artificial Ligament and the Kennedy Ligament Augmentation Device (LAD). Emphasis is placed on the Ligament Advanced Reinforcement System (LARS) as preliminary investigations of its use have been encouraging. Significant progress has been made recently with respect to the understanding of ACL anatomy, composition, biomechanics, and healing processes, leading to innovative techniques using approaches based in tissue engineering principles and computer – assisted surgery. While research into improved ACL treatment options continues, the synthesis of recent advancements provides a new optimism towards the regeneration of an ACL mirroring its original stability, function, and longevity.


  1. Nau T, Lavoie P, Duval N, A new generation of artificial ligaments in reconstruction of the anterior cruciate ligament. Two-year follow-up of a randomised trial. J Bone Joint Surg Br.,
  2. 84(3): p. 356-60.
  3. Talbot M, Berry G, Fernandes J, Ranger P, Knee dislocations: experience at the Hopital du Sacre-Coeur de Montreal. Can J Surg., 2004. 47(1): p. 20-4.
  4. Lukianov AV, Richmond JC, Barrett GR, Gillquist J, A multicenter study on the results of anterior cruciate ligament reconstruction using a Dacron ligament prosthesis in "salvage" cases. Am J Sports Med., 1989. 17(3): p. 380-5.
  5. Krudwig WK, Anterior cruciate ligament reconstruction using an alloplastic ligament of polyethylene terephthalate (PET -- Trevira -- hochfest). Follow-up study. Biomed Mater Eng.,
  6. 12(1): p. 59-67.
  7. Lidén M, Ejerhed L, Sernert N, Laxdal G, Kartus J, Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction: a prospective, randomized study with a 7-Year follow-up. Am J Sports Med. 2007 May;35(5):740-8.
  8. Koski JA, Ibarra C, Rodeo SA., Tissue-engineered ligament: cells, matrix, and growth factors. Orthop Clin North Am., 2000. 31(3): p. 437-52.
  9. Petrigliano FA, McAllister DR,Wu BM, Tissue engineering for anterior cruciate ligament reconstruction: a review of current strategies. Arthroscopy. 2006 Apr;22(4):441-51.
  10. Burnett QM 2nd, Fowler PJ, Reconstruction of the anterior cruciate ligament: historical overview. Orthop Clin North Am. 1985 Jan;16(1):143-57.
  11. Ahlfeld SK, Larson RL, Collins HR, Anterior cruciate reconstruction in the chronically unstable knee using an expanded polytetrafluoroethylene (PTFE) prosthetic ligament. Am J Sports Med. 1987 Jul-Aug;15(4):326-30.
  12. James SL, Kellam JF, Slocum DB, Larsen RL, The proplast prosthetic ligament stent as a replacement for the cruciate ligaments of the knee. Aktuelle Probl Chir Orthop., 1983.
  13. (116-20).
  14. Woods, GW, Synthetics in anterior cruciate ligament reconstruction: a review. Orthop Clin NorthAm., 1985. 16(2): p. 227-35.
  15. Jenkins, DHR, The repair of cruciate ligaments with flexible carbon fibre: A longer term study of the induction of new ligaments and of the fate of the implanted carbon. J Bone Joint Surg Br., 1978. 60-B(4): p. 520-2.
  16. Alexander H, Weiss AB, Parsons JR., Absorbable polymerfilamentous carbon composites--a new class of tissue scaffolding materials. Aktuelle Probl Chir Orthop., 1983. 26: p. 78-91.
  17. Weiss, AB, Blazina ME, Goldstein AR, Alexander H, Ligament replacement with an absorbable copolymer carbon fiber scaffold--early clinical experience. Clin Orthop., 1985. 196(77-85).
  18. Mody BS, Howard L, Harding ML, Parmar HV, Learmonth DJ, The ABC carbon and polyester prosthetic ligament for ACLdeficient knees. Early results in 31 cases. J Bone Joint Surg Br. 1993 Sep;75(5):818-21.
  19. Bolton CW, Bruchman WC, The GORE-TEX expanded polytetrafluoroethylene prosthetic ligament. An in vitro and in vivo evaluation. Clin Orthop., 1985. 196: p. 202-13.
  20. Glousman R, Shields C Jr, Kerlan R, et al., Gore-Tex prosthetic ligament in anterior cruciate deficient knees. Am J Sports Med.,1988. 16(4): p. 321-6.
  21. Woods GA, Indelicato PA, Prevot TJ, The Gore-Tex anterior cruciate ligament prosthesis. Two versus three year results. Am J Sports Med., 1991. 19(1): p. 48-55.
  22. Indelicato PA, Pascale MS, Huegel MO, Early experience with the GORE-TEX polytetrafluoroethylene anterior cruciate ligament prosthesis. Am J Sports Med., 1989. 17(1): p. 55-62.
  23. Arnoczky SP,Warren RF, Minei JP, Replacement of the anterior cruciate ligament using a synthetic prosthesis. An evaluation of graft biology in the dog. Am J Sports Med. 1986 Jan- Feb;14(1):1-6.
  24. Richmond JC, Manseau CJ, Patz R, McConville O, Anterior cruciate reconstruction using a Dacron ligament prosthesis. A long-term study. Am J Sports Med., 1992. 20(1): p. 24-8.
  25. Barrett GR, Lawrence L Jr, SheltonWR, Manning JO, Phelps R, The Dacron ligament prosthesis in anterior cruciate ligament reconstruction. A four-year review. Am J Sports Med., 1993. 21(3): p. 367-73.
  26. Lopez-Vazquez E, Juan JA, Vila E, Debon J, Reconstruction of the anterior cruciate ligament with a Dacron prosthesis. J Bone Joint Surg Am., 1991. 73(9): p. 1294-300.
  27. Fujikawa K, Iseki F, Seedhom BB, Arthroscopy after anterior cruciate reconstruction with the Leeds-Keio ligament. J Bone Joint Surg Br., 1989. 71(4): p. 566-70.
  28. Macnicol MF, Penny IA, Sheppard L, Early results of the Leeds-Keio anterior cruciate ligament replacement. J Bone Joint Surg Br., 1991. 73(3): p. 377-80.
  29. McLoughlin SJ, Smith RB, The Leeds-Keio prosthesis in chronic anterior cruciate deficiency. Clin Orthop., 1992. 283: p. 215-22.
  30. Rading J, Peterson L, Clinical experience with the Leeds-Keio artificial ligament in anterior cruciate ligament reconstruction.A prospective two-year follow-up study. Am J Sports Med., 1995.
  31. (3): p. 316-9.
  32. Schindhelm K, Rogers GJ, Milthorpe BK, et al., Autograft and Leeds-Keio reconstructions of the ovine anterior cruciate ligament. Clin Orthop., 1991. 267: p. 278-93.
  33. Kennedy JC, Roth JH, Mendenhall HV, Sanford JB, Presidential address. Intraarticular replacement in the anterior cruciate ligament-deficient knee. Am J Sports Med., 1980. 8(1): p. 1-8.
  34. Zoltan DJ, Reinecke C, Indelicato PA, Synthetic and allograft anterior cruciate ligament reconstruction. Clin Sports Med., 1988. 7(4): p. 773-84.
  35. Hanley P, Lew W, Lewis JL, Hunter RE, Kirstukas S, Kowalczyk C, Load sharing and graft forces in anterior cruciate ligament reconstructions with the Ligament Augmentation Device. Am J Sports Med., 1989. 17(3): p. 414-22.
  36. Kdolsky RK, Gibbons D, Kwasny O, Schabus R, Plenk H Jr, Braided polypropylene augmentation device in reconstructive surgery of the anterior cruciate ligament: long-term clinical performance of 594 patients and short-term arthroscopic results, failure analysis by scanning electron microscopy, and synovial histomorphology. J Orthop Res., 1997. 15(1): p. 1 10.
  37. Kumar K, Maffulli N, The ligament augmentation device: an historical perspective. Arthroscopy, 1999. 15(4): p. 422-32.
  38. Lavoie P, Fletcher J, Duval N, Patient satisfaction needs as related to knee stability and objective findings after ACL reconstruction using the LARS artificial ligament. Knee, 2000. 1(7): p. 157-63.
  39. Fanelli GC, Evaluation and treatment of the multiple ligament injured knee. Arthroscopy. 2003 Dec;19 Suppl 1:30-7.
  40. Altman GH, Horan R, Lu HH, Moreau J, Martin I, Richmond JC, Kaplan DL, Silk matrix for tissue engineered anterior cruciate ligaments. Biomaterials., 2002. 23(20): p. 4131-41.
  41. Bourke SL, Kohn Joachim, Dunn MG, Preliminary development of a novel resorbable synthetic polymer fiber scaffold for anterior cruciate ligament reconstruction. Tissue Eng., 2004. 10(1-2): p. 43-52.
  42. Caruso, AB, Dunn MG, Changes in mechanical properties and cellularity during long-term culture of collagen fiber ACL reconstruction scaffolds. J Biomed Mater Res A, 2005. 73(4): p.
  43. -97.
  44. Bellincampi LD, Closkey RF, Prasad R, Zawadsky JP, Dunn MG, Viability of fibroblast-seeded ligament analogs after autogenous implantation. J Orthop Res., 1998. 16(4): p. 414-20.
  45. Cao Y, Vacanti J, Ma X, et al., Generation of neo-tendon using synthetic polymers seeded with tenocytes. Transplant Proc., 1994. 26(6): p. 3390-2.
  46. Ouyang, HW, Toh SL, Goh J, Tay TE,Moe K,Assembly of bone marrow stromal cell sheets with knitted poly (L-lactide) scaffold for engineering ligament analogs. J Biomed Mater Res B Appl Biomater, 2005. 75B(2): p. 264-271.
  47. Lee J, Green MH, Amiel D, Synergistic effect of growth factors on cell outgrowth from explants of rabbit anterior cruciate and medial collateral ligaments. J Orthop Res., 1995. 13(3): p. 435-41.
  48. Schmidt CC, Georgescu HI, Kwoh CK, Blomstrom GL, Engle CP, Larkin LA, Evans CH, Woo SL, Effect of growth factors on the proliferation of fibroblasts from the medial collateral and
  49. anterior cruciate ligaments. J Orthop Res., 1995. 13(2): p. 184-90.
  50. Murray MM, Rice K, Wright RJ, Spector M, The effect of selected growth factors on human anterior cruciate ligament cell interactions with a three-dimensional collagen-GAG scaffold. J
  51. Orthop Res, 2003. 21(2): p. 238-44.
  52. Muller-Alsbach, UW, Staubli, AE, Computer aided ACL reconstruction. Injury, 2004. 35 Suppl 1: p. S-A65-7.
  53. Schep NW, Stavenuiter MHJ, Diekerhof CH, et al., Intersurgeon variance in computer-assisted planning of anterior cruciate ligament reconstruction. Arthroscopy, 2005. 21(8): p. 942-7.


Download data is not yet available.