Early on, for me, we started using Poly-Tapes, especially for our patellar tendon and quadriceps ruptures, so any extensor mechanism injuries, especially the really bad ones you get after a knee replacement, which really take away the confidence from the patient and the surgeon.

With the Poly-Tape, we found that it improves the rehab, and we've been using it for 7 years. Our longest follow-up is about 7 years, with MRI data showing excellent results. We're continuing to use it for patients and doing pre- and post op MRIs at different timepoints in follow-up, and I can say the recovery's immence, they don't go backwards, they continue to go forward in their recovery after replacement. Even after a sports injury, the really bad ones, where they do have extensor mechanism injuries, again, it's a real game changer, so I really do believe they have a very important role to play.

A really important thing for me is that the exposure when you're doing an extensor mechanism reconstruction is much less; you can work with much smaller incisions, a lot of it is percutaneous, you can shuttle under the skin. It's just so much better for the patients; there's a lot of technique available on the website, and we've got a few videos that have been put out there as well. It's simple surgery; anyone can do it. So I think it's really worth having. 

We see our patients standard after the rehab, at 2 weeks during suture removal. I had a patient from the Middle East, and what really shook me was the patient, who stood up and kicked his knee straight. I said, 'Don't do that, ' but he said, 'I'm fine, I'm all good, ' and we hadn't even taken his stitches out, and that's what really gave me the confidence. Talking to my fellow colleagues, they were actually saying that the actual patients could feel the difference in his knee, and actually showed me that he was doing well.

We collect PROM scores, look at KOOS scores, and look at their IKDC scores, and they are all doing consistently well. Even the older age groups they're all doing very well, so I am very happy. It makes a very difficult surgery a very simple surgery, and I think it's well worth having it as your first choice.

It's very simply strength on day one. The synthetic gives the patient confidence in strength on day one, and it has also instilled a lot of confidence in me, meaning rehab is much faster, we can catch them up much quicker and get them moving much faster, so that's really where it comes from.

I've also been using it for my multi-ligament cases. When you don't have enough graft, it's definitely a lifesaver; you don't need to go harvest all of their tendons.

In my practice, I truly don't like using allografts, so it's always another graft, and now with the synthetics, I've definitely been reaching out for them more often, and have been using them for my MCLs when they're indicated, my PLCs as well. They really are a game-changer for those sorts of injuries.

A normal [ACL] autograft has to undergo apoptosis, and it can hit its weakest point at 6 weeks. And someone who is 6 weeks after surgery, you expect them to continue to get stronger, but actually it's the other way round, as the graft is at its weakest point. And it's from these 6 weeks we begin to see the ligamentisation process, and that's where we have rehab that's prescribed to slowly get that graft to ligamentise and become what the ACL used to be.

With a synthetic ligament, you have strength on day one, so I think it's really going to affect the way we can actually get this patient back, which is going to be a really important factor

We still have graft site morbidity. I think it's really important to know that a lot of us have moved away from hamstring tendons and moved to quads, with some of us looking at the peroneus. We've got data to suggest at 2 years, the hamstring still isn't the same as the opposite side, which has really made me think about whether I want to take something that is an anterior restraint for the tibia, and works alongside the ACL. Why would I sacrifice a graft? 

I think we're really in a position to start thinking about do we have other options, and I know the synthetics have had some bad experiences, and I think there is lots of reasons for that, but I think it's time to be really open to the act that we are evolving and learning more and more, and it would be a huge step forward if we didn;t have to use an autograft, and had something on the shelf that could just bring a patient back to full function much faster, especially since we've got lots of sports happening, with a huge economic advantage to the athlete if they can get back to sports faster.