Patient-reported outcomes after anterior cruciate ligament reconstruction with the JewelACL synthetic ligament: Multicenter study of at least 9 years follow-up.

Abstract

Purpose: Synthetic grafts for anterior cruciate ligament (ACL) reconstruction aim to address limitations of biological grafts, such as donor-site morbidity and delayed recovery. JewelACL is a synthetic scaffold developed to enhance biological integration and mechanical durability. This multicenter study evaluated long-term patient-reported outcomes, adverse events, re-rupture rates and return-to-sport outcomes following ACL reconstruction using JewelACL, with a minimum follow-up of 9 years.

Methods: A retrospective cohort of 58 patients who underwent ACL reconstruction between 2010 and 2014, using either JewelACL alone (n = 44) or JewelACL combined with hamstring autograft (hybrid technique; n = 14), was assessed. Patient-reported outcome measures (PROMs), including the International Knee Documentation Committee (IKDC), Lysholm and Tegner scores, as well as complication and re-rupture rates, were analysed. Long-term follow-up was based on telephone-administered PROMs; no standardised clinical laxity testing or imaging (magnetic resonance imaging or x-ray) was performed.

Results: At a mean follow-up of 10.8 ± 0.9 years, the re-rupture rate was (5.2%) 3 cases out of 58. Median Lysholm and IKDC scores were 100 (interquartile range [IQR] 91-100) and 95 (IQR 89-99), respectively, indicating excellent long-term knee function. The mean Tegner score at follow-up was 5.2 ± 1.7, representing a modest decline from the pre-injury level of 6.5, consistent with age-related reductions in activity. No patient-reported infections or hospital admissions related to the operated knee were reported. IKDC scores were significantly higher in the JewelACL-only group than in the hybrid group (p = 0.02), while Lysholm and Tegner scores did not differ significantly.

Conclusions: ACL reconstruction using JewelACL was associated with excellent long-term PROMs, low re-rupture rates and high return-to-sport rates. Although these findings are encouraging, interpretation is limited by the retrospective design, substantial loss to follow-up and the absence of imaging or objective clinical assessments. There was no statistically significant difference in return-to-sport rates between the JewelACL group (85%) and the hybrid group (86%) (p = 1.00).

Level of evidence: Level IV.