It's still a real issue though: As an ISP you can't run a mail server that doesn't accept mails from the one client that's most used among your customers.
Yes. Outlook isn't conforming to the spec, but it's also being actively used and even if you could put pressure on Microsoft to fix it (good luck doing that back in the early 00s), you can't possibly force all your customers to update.
Now you have three options:
1. you switch MTA to one that can deal with the non-conforming clients.
2. you add a proxy server that interfaces between the non-conforming clients and your MTA
3. you patch your MTA
Unfortunately, because of qmail's good reputation ("hey! we're running qmail that never had security issues!") and because of the lack of abilities of your run of the mill ISP to write a scaling SMTP proxy, what people have traditionally have done is option 3.
What they forget about option 3 is that the one big advantage of that solution ("hey! we're running qmail") isn't valid any more because you're not exactly running qmail any more. You're running qmail plus some additional patches that actually touch the public interface of your MTA and are thus exposed to the network. To unauthenticated users.
So IMHO, they should have gone with option 1) or, nowadays where it's easier to write a well-scaling SMTP proxy thanks to the raise of asynchronous event based communication, option 2, but you'd better be sure you're not introducing security flaws in your reverse proxy.
It's not a real issue because those clients don't exist anymore.
Nearly twenty years ago when they did, (4) I could use fixcrio (which is hardly a proxy server): I simply ran it one of the ports that accepted mail from MUAs directly.
https://cr.yp.to/docs/smtplf.html