Synthetic grafts in the treatment of ruptured anterior cruciate ligament of the knee joint

The anterior cruciate ligament (ACL) is cited as the most frequently injured ligament in the knee. The standard treatment of ACL injury remains ligament reconstruction followed by a postoperative physiotherapeutic procedure. During the reconstruction, the torn ligament can be replaced with an autograft or an allograft. A synthetic ligament is also one of the available graft options. Synthetic grafts in ruptured ACL treatment have been used as scaffolds, stents, or prostheses. The story of using synthetic materials in ACL deficient knee treatment started in the beginning of the 20th century with the usage of silk and silver fibers. The second half of the 20th century abounded in new synthetic materials being proposed as torn ACL replacements, such as Supramid®, Teflon® or Dacron®, Proplast®, carbon fiber graft, ABC graft, Kennedy-LAD®, Trevia, Leeds-Keio, Gore-Tex®, PDS®, EULIT®, and Polyflex® or LARS®. Artificial ligaments have intrigued surgeons for all these years as they represent the hope for grafts that are easily available and stronger than soft tissue "off-the-shelf" grafts, simplifying the surgery, and avoiding graft harvesting and donor site morbidity. However, most of the artificial grafts have been characterized by high rates of failure. One of the very few synthetic grafts gaining more widespread popularity has been LARS®. However, it is suggested that the ligament not be considered as a potential graft for primary reconstruction of the ACL, and it should be rather treated as an alternative graft in special cases, so the optimal synthetic graft material remains controversial.