Unfortunately, I did not use any of the synthetics. My knowledge about synthetics is as good as in textbooks and research papers, and I was quite discouraged about those reports. I was pleasantly surprised when I came across the Xiros JewelACL device. When I got closer to the device, I realised this is a fantastic addition to our options when dealing with complex cases.

It [JewelACL] has filled a gap which I felt while doing a lot of complex cases, which were flown from the Periphery Referral Centres with complex revisions, complex multi-ligament injuries. This is where synthetic ligaments help us give good outcomes to patients.

We use it [JewelACL] for intra-articular ligament reconstruction in especially challenging cases, such as hyperlaxity females, BMI > 35/40, revision reconstructions, primary PCL reconstruction, and multi-ligament cases where there are limted chouce for the graft.

There are many patients, especially females and middle-aged males, who would like to get back to their normal life faster, without sacrificing their own biological tissue and prolonged rehab.

This is where a synthetic off-the-shelf helps them and the surgeon finish up the procedure faster, and rehabilitation is much quicker after that, as well as recovery. From a patient's point of view, this helps them.

Extremely satisfactory!

Patients immediately tell you they had minimal to no pain postoperatively, and they tell you they got back to their daily activities very fast, with professional activities not suffering as long as expected when they visited other surgeons who offered biological grafts, who explained they would need longer rehabilitation.

The amount of exercise or physiotherapy required post-operatively is reduced

For the medial side of the knee, there are many cases where ACL is associated with MCL insufficiency, and the hamstring graft is often not required to be sacrificed due to being used in the ACL. This is where you should start using synthetics.

Another indication is the MPFL reconstruction, where the thin gracilis graft can stretch over time, and actually can make your results inferior to the time of implantation.

I would advise you to take the plunge straight away into intra-articular ACL reconstruction, because that is the most familiar kind of surgery which most arthroscopy surgeons are familiar with, and can immediately get the hang of things.