Anterior Cruciate Ligament Prosthesis: “Programmed Loosening” Augmentation as a Solution to the Problem

Abstract

The experience gained in recent years has shown that true prosthetic replacement of the A.C.L; must be considered a temporary solution of the problem.

The mechanical stresses that develop during walking or running inevitably cause more or less rapid rupture of the synthetic material so that the reconstruction gesture fails.

However, the prosthetic ligament concept is not to be thought of as exhausted if one considers the possibility of using this prosthesis associated to the implantation of autologous tendons in accordance with the augmentation concept.

In practice the synthetic ligament guarantees stability of the implant during the early re-education period while the autologous ligament assumes the lasting mechanical characteristics of over the years. It is precisely the yielding of the artificial prosthesis which, paradoxically favours progressive transmission in time of the articular mechanical stresses to the biological implant, thus encoucaging maturation of a proper neoligament.

In practice, the association of an artificial ligament to a biological graft makes it possible to rapidly achieve re-education times similar to those of plastics with prosthetic ligaments, but possessing the unlimited duration typical of biological reconstructions.