Late-onset osteolysis and pathologic tibial plateau fracture following synthetic Gore-Tex ACL and PCL grafts: a complication after 38 years.

Gore-Tex or expandable polytetrafluorethylene (ePTFE) was commonly used for synthetic ACL and PCL graft reconstruction in the late 1980s, but was discontinued owing to high failure rates and osteolytic complications. While this is an uncommon complication within the initial 20 years of post-graft implantation, the effects of these ligaments at much longer follow-up have little documentation due to increasing rarity. We present a case of a 64-year-old male with massive osteolysis first suspected to be extensive subchondral cystic changes secondary to advanced osteoarthritis. Two years after the initial presentation of knee pain, the patient represented with a tibial plateau fracture through the massive osteolytic lesion. CT imaging and pathology favored particle wear osteolysis secondary to the implanted grafts. The patient was treated with partial graft removal and TKA with a revision-style tibial stem. This case highlights the rare, long-term complications of synthetic ligament grafts, including progressive osteolysis and pathologic fracture decades after implantation. Synthetic graft-related osteolysis should be considered in patients with a remote history of graft reconstruction presenting with late-onset joint instability or fractures. CT imaging is crucial in evaluating the degree of osteolysis as a staged surgical approach with bone grafting may be necessary for severe cases.