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Journal of Long-Term Effects of Medical Implants

ISSN Print: 1050-6934
ISSN Online: 1940-4379

Journal of Long-Term Effects of Medical Implants

DOI: 10.1615/JLongTermEffMedImplants.v10.i4.20
14 pages

Anterior Cruciate Ligament Reconstruction with the Leeds-Keio Artificial Ligament

Kyosuke Fujikawa
Knee Disease Centre, Ohtsuki Hospital for Surgery, Tokyo; Professor of Orthopaedic Surgery. Department of Orthopredic Surgery National Defense Medical College, Saitama, Japan
Tatsuo Kobayashi
Department of Orthopaedic Surgery, National Defense Medical Collage, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
Yoshihiro Sasazaki
Department of Orthopaedic Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
Hideo Matsumoto
Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
Bahaa B. Seedhom
Rheumatology and Rehabilitation Research Unit, University of Leeds, 36 Clarendon Road, Leeds LS 2 9NZ, NK

ABSTRACT

The Leeds-Keio (L-K) artificial ligament, developed for knee ligament reconstruction, is made of polyester with a maximum tensile strength of 2200 N. This implant works not only as a ligament but also as a scaffold onto which natural tissue grows from synovium. In an animal experiment, each strand of the L-K ligament was covered with new tissue by 2-3 weeks after anterior cruciate ligament reconstruction. Eight weeks postoperatively, abundant fibrous tissue with extensive vascularity covered the implant, which was still histologically immature. After 16 weeks, vascularization and tissue induction began to subside, and histologic analysis showed dense fibers running longitudinally and parallel. By 36 weeks, the new ligament looked like a natural anterior cruciate ligament, although histologically more cells could be seen than in the natural ligament. This maturation was observed only when the substitute was implanted under good tension. Clinically, the surgical procedure has been improved over the past 10 years, to the current practice in which the tape-in-tube double L-K ligament employs a small piece of autogenous tissue to promote early tissue induction and maturation. Using this practice (n = 135), more than 85% of the patients were satisfied subjectively, objectively, and arthroscopically at the 5-year postoperative FU period. Few patients had joint effusion postoperatively. Sacrifice of autogenous tissue is minimal. The patient can return to activities of daily living within 2 weeks, and more than 50% of them to sports within 10 weeks, and the new ligament is expected to keep its function for a long period as ingrowth completes the structure biologically.