My journey with synthetic ligaments started with myself. When I was 18, I tore my ACL in my right knee, and I'll never forget sitting there with an excellent surgeon, as it happened, very inspirational and probably the reason why I do what I do now.

When he said to me, "What we're going to do is we're going to take a third of your patellar tendon and a bit of bone at each end, and we're going to replace your ACL."

And conceptually, in my mind, I'm confused. I can't work out why I just had a big injury to my knee, and this gentleman is going to injure it further to try and make it better.

So I asked, "Is there another option?"

To which he said, "Yes."

"What would that be?"

"Well, we can take your hamstrings tendons instead."

Again, conceptually, I'm thinking, "Why?" Surely there's got to be another way, but evidently not, so let's just go ahead with the patella tendon.

Well, the surgery went well. I returned to sport, and I was doing okay. I get anterior knee pain. I have pain when I'm kneeling down. So it sparked my interest when I became a surgeon myself to think, "Could we avoid donor site morbidity?" And that sparked my interest in synthetic ligaments.

I had a patient in my first year as a consultant; he had bilateral ACL tears, having had previous hamstring grafts and previous patellar tendon grafts in each knee, so we were running out of grafts, and this was before quad tendon really became popular, so in my mind, the only real option was an allograft for him. 

He was adamant for some social reasons that he would not have a donated bit of tissue, and it was he who actually said that surely there was a synthetic tape of something you could put in instead. 

And simply from being at various conferences over the years, I remembered the JewelACL. That’s when I reached out to the team to see if that was an option.

That was the first case. And since then it's just snowballed because that's quite a complex case to try something that you're not convinced of. 

So, if it worked in that, it built a lot of credence and credit within me to be confident to use it going forward. And that's where it started and now we're further down that journey.

What we know about the JewelACL is that it's made of a polyester. It's woven in a particular way and it is plasma treated. And that's three features that make it more biocompatible.

And we know from studies that have been performed that it is biocompatible. We know that it doesn't cause synovitis even when it tears again.

And I've experienced that now myself. On the occasions where I've inserted the JewelACL and it has re-ruptured, I've biopsied the synovium and we don't see the synovitis that we're fearful of.

I view a few benefits for the patient with using the synthetic ACL. The immediate benefit is the lack of donor site morbidity. If you lose a third of your patellar tendon, a third of your quadriceps tendon, two of your hamstrings tendons, that's going to leave you with a deficit.

And we might fool ourselves, think, "Oh, the patients are all right." But irrespective of whatever it is, there will be some degree of deficit. The human body's not designed to be carved up that way.

So that's the immediate benefit for the patient, no donor site morbidity.

The short-term benefit is potentially a quicker rehabilitation. Less of an insult to the knee at the time of surgery, and so a quicker recovery for the individual, potentially a quicker return to sport as well.

And then the longer-term benefit would potentially be in the event of a re-rupture.

I don't think any graft is impossible to re-rupture, and the synthetics are no different. They have a yield point, and a load can tear the synthetic ligament as well.

But the advantage of using a JewelACL is that we can insert that through a smaller diameter tunnel, which means that when it comes to a revision, there's more bone stock available. So we can either expand the tunnels, get new fresh bleeding bone, or, if possible, put it in the same tunnel.

Over the last nine years now, I'm getting on for having inserted almost 100 JewelACLs.

I started quite sceptically. I started with a very complex patient. He did great. That gave me confidence to use it for more and more patients. And as with most of these things, the more comfortable you get, the more you're going to use it.

I've been delighted with the results, with the outcomes. I think my patients are very happy with them as well.

I have had some failures, some re-ruptures, but my rate of re-ruptures is lower when I've used a JewelACL than when I've used an autograft.

And so, for me, I'm pretty happy with the outcomes.