Patterns of failure with time of an artificial scaffold class ligament used for reconstruction of the human anterior cruciate ligament

A composite carbon fibre polyester scaffold class ligament (ABC — Active Biosynthetic Composite Ligament, Surgicraft Ltd., Redditch) has been used for primary reconstruction of the torn anterior cruciate ligament at Mayday University Hospital since 1985. A cohort of patients followed up until 1996 showed a high incidence of early failure of the implant due to rupture and stretching. This led to a detailed mode of failure analysis and as a result the surgical technique was modified and new instrumentation was introduced in 1992 leading to a substantial improvement in early and mid-term survivorship. However, from 1996 onwards a large number of patients was lost to follow-up and therefore in 2000 a second cohort of patients was recalled for retrospective review. All the patients in this cohort had undergone surgery after 1992 and following the introduction of new instrumentation and alteration in surgical technique. Review of the results in the second cohort showed a very low initial failure rate (0% in the first 3 years), but with an increasing incidence of failure (27.9%) noted between 5 and 7 years post-operatively.