Early experience with the GORE-TEX polytetrafluoroethylene anterior cruciate ligament prosthesis

Abstract

A prospective study of 41 patients with acute and chronic ACL deficiency underwent reconstruction with the GORE-TEX polytetrafluoroethylene (PTFE) ACL prosthesis beginning in November 1983. Thirty-nine patients who were at least 2 years from their surgical procedure were available for follow-up evaluation, which included subjective questionnaire, clinical exam ination, and instrumented ligamentous laxity tests. Eight patients had an acute injury to the ACL and 31 patients had chronic ACL insufficiency for which recon struction was performed. Thirty-four patients had satisfactory results, allowing full return to activity with no appreciable symptomatol ogy. Of the remaining five patients, four had a complete rupture of the prosthesis. The average knee arthrome tric measurement improved from a 5.4 mm left/right difference preoperatively to a 2.0 mm left/right differ ence at 2 year followup. Nine patients had postopera tive complications of one or more atraumatic episodes of a sterile effusion. Six patients had recurrent effu sions ; in five, arthroscopy revealed partial tears of less than one-third of the prosthesis. Three patients who had recurrent effusions had PTFE particles in their synovial biopsies. One patient had an immediate post operative infection and to date has had salvage of the prosthesis and currently has a stable knee with full return to activities. Based on the early results of this study, the GORE- TEX PTFE ACL prosthesis provided a satisfactory method of reconstruction for ACL deficient knees. Based on the evaluation used, 87% of the patients had satisfactory results. Problems associated with use of this prosthesis include partial or complete tears of the prosthesis and sterile effusions, possibly due to syno vial irritation from the PTFE particles. Appropriate placement of the graft, anterior and posterior notch plasty, and removal of sharp edges from the bony tunnels may help eliminate these problems.