Carbon Fiber Ligament Replacement in Chronic Knee Instability

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Abstract
Procedures currently acknowledged or still accepted and performed in the operative treatment of chronic instability of the knee include autogeneic, allogeneic, and xenogeneic grafts or alloplastic materials such as carbon fibers. After years of experimental studies of the carbon material itself and its behavior in animals, the following facts have been established. Carbon fibers possess a good biocompatibility, have favorable elasticity (by use of a band with a braid angle of 43 degrees), and permit the ingrowth of collagenous fibers between the carbon fibers of the prosthesis. With carbon fibers, an anatomic reconstruction of the injured ligament is possible. These fibers must be incorporated in bone to provide a long-lasting anchorage. For fixation, the band is pulled through bone channels or put under a trap door at the site of the original ligament insertion. Since ruptures have occurred when pure carbon strands were used intra-articularly, a coat of resorbable collagen has been applied. In addition, the intra-articular segment of the band is enveloped in a sheet of dura or fascia lata, thus providing stability against shear stresses. Of 64 patients followed up over 13.6 months on average, 60 were satisfied: 28 had stable knees; 30 had minor instability; and six were unstable. The range of movement was equal to the unaffected side in 37, slightly decreased in 23, and much reduced in four cases.
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