Primary ACL reconstruction using the LARS device is associated with a high failure rate at minimum of 6-year follow-up View Full Text


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Article Info

DATE

2019-03-22

AUTHORS

Scott John Tulloch, Brian Meldan Devitt, Tabitha Porter, Taylor Hartwig, Haydn Klemm, Sam Hookway, Cameron John Norsworthy

ABSTRACT

PurposeThe Ligament Augmentation and Reconstruction System (LARS®) is a synthetic ligament consisting of fibres made of polyethylene terephthalate. Despite the LARS being used as an anterior cruciate ligament (ACL) device for nearly 30 years and the well-documented complications from earlier synthetic ligament designs, there is a paucity of published medium- to long-term results. The aim of this study is to report the clinical and functional outcomes after ACL reconstruction using the LARS at a minimum follow-up of 6 years.MethodsResults of a single surgeon’s entire cohort of 55 patients who underwent primary LARS ACL surgery were reviewed at a median of 7.8 years (6.0–9.4). Patient-reported outcome measures including the International Knee Documentation Committee (IKDC) score and 36-Item Short Form Health Survey (SF-36) were collected and clinical assessment consisted of range of motion (ROM) and the KT-1000 arthrometer to assess the side–side difference in the operative and non-operative knee. Mechanical failures of the graft were confirmed at revision surgery and a survivorship analysis was performed using the Kaplan–Meier method.ResultsThe overall mechanical failure rate was 17/51 (33.3%) with ruptures occurring at a median 3.9 years (0.6–8.8 years) following primary LARS ACL surgery. Secondary operative procedures were performed in 39.2% of patients. For intact grafts, there was no statistically significant difference is side-to-side ROM or anterior knee laxity and subjective scores revealed a median IKDC subjective score of 85.1 (26.4–100) and SF-36 physical component score of 94.1.ConclusionThe rates of LARS ACL construct failure (33.3%) in this cohort are high and based on these results the LARS should not be considered as a graft option for primary ACL reconstruction.Level of evidenceIII, cohort study. More... »

PAGES

3626-3632

References to SciGraph publications

  • 2009-04-25. Four-strand hamstring tendon autograft versus LARS artificial ligament for anterior cruciate ligament reconstruction in INTERNATIONAL ORTHOPAEDICS
  • 2018-11-08. Synovitis following anterior cruciate ligament reconstruction using the LARS device in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2003-08-14. Harvesting hamstring tendons for ACL reconstruction influences postoperative hamstring muscle performance in ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
  • 2012-09-14. Anterior cruciate ligament reconstruction with the ligament augmentation and reconstruction system: a systematic review in INTERNATIONAL ORTHOPAEDICS
  • 2012-09-19. Bone–patellar tendon–bone autograft versus LARS artificial ligament for anterior cruciate ligament reconstruction in EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY
  • 2012-09-25. Outcomes for primary anterior cruciate reconstruction with the quadriceps autograft: a systematic review in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2013-06-29. Anterior cruciate ligament reconstruction with LARS™ artificial ligament results at a mean follow-up of eight years in INTERNATIONAL ORTHOPAEDICS
  • 1995-07. Long-term results of the Leeds-Keio anterior cruciate ligament reconstruction in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2014-11-07. Hamstring tendon autograft versus LARS artificial ligament for arthroscopic posterior cruciate ligament reconstruction in a long-term follow-up in ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
  • 2013-08-27. Intra-articular remodelling of hamstring tendon grafts after anterior cruciate ligament reconstruction in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
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    http://scigraph.springernature.com/pub.10.1007/s00167-019-05478-3

    DOI

    http://dx.doi.org/10.1007/s00167-019-05478-3

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/30903217


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    35 schema:description PurposeThe Ligament Augmentation and Reconstruction System (LARS®) is a synthetic ligament consisting of fibres made of polyethylene terephthalate. Despite the LARS being used as an anterior cruciate ligament (ACL) device for nearly 30 years and the well-documented complications from earlier synthetic ligament designs, there is a paucity of published medium- to long-term results. The aim of this study is to report the clinical and functional outcomes after ACL reconstruction using the LARS at a minimum follow-up of 6 years.MethodsResults of a single surgeon’s entire cohort of 55 patients who underwent primary LARS ACL surgery were reviewed at a median of 7.8 years (6.0–9.4). Patient-reported outcome measures including the International Knee Documentation Committee (IKDC) score and 36-Item Short Form Health Survey (SF-36) were collected and clinical assessment consisted of range of motion (ROM) and the KT-1000 arthrometer to assess the side–side difference in the operative and non-operative knee. Mechanical failures of the graft were confirmed at revision surgery and a survivorship analysis was performed using the Kaplan–Meier method.ResultsThe overall mechanical failure rate was 17/51 (33.3%) with ruptures occurring at a median 3.9 years (0.6–8.8 years) following primary LARS ACL surgery. Secondary operative procedures were performed in 39.2% of patients. For intact grafts, there was no statistically significant difference is side-to-side ROM or anterior knee laxity and subjective scores revealed a median IKDC subjective score of 85.1 (26.4–100) and SF-36 physical component score of 94.1.ConclusionThe rates of LARS ACL construct failure (33.3%) in this cohort are high and based on these results the LARS should not be considered as a graft option for primary ACL reconstruction.Level of evidenceIII, cohort study.
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    42 schema:keywords ACL reconstruction
    43 ACL surgery
    44 Form Health Survey
    45 Health Survey
    46 IKDC subjective score
    47 International Knee Documentation Committee score
    48 KT
    49 Kaplan-Meier method
    50 LARS
    51 LARS device
    52 Level of evidenceIII
    53 MethodsResults
    54 SF-36 physical component score
    55 Short Form Health Survey
    56 aim
    57 analysis
    58 anterior knee laxity
    59 arthrometer
    60 assessment
    61 augmentation
    62 clinical assessment
    63 cohort
    64 cohort study
    65 complications
    66 component scores
    67 construct failure
    68 design
    69 devices
    70 differences
    71 entire cohort
    72 evidenceIII
    73 failure
    74 failure rate
    75 fibers
    76 functional outcome
    77 graft
    78 graft options
    79 high failure rate
    80 intact graft
    81 knee
    82 knee laxity
    83 laxity
    84 levels
    85 ligament
    86 ligament augmentation
    87 long-term results
    88 measures
    89 mechanical failure
    90 mechanical failure rate
    91 median
    92 median IKDC subjective score
    93 medium
    94 method
    95 minimum
    96 motion
    97 non-operative knee
    98 operative procedure
    99 options
    100 outcome measures
    101 outcomes
    102 overall mechanical failure rate
    103 patient-reported outcome measures
    104 patients
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    106 physical component score
    107 polyethylene
    108 primary ACL reconstruction
    109 procedure
    110 range
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    112 rate
    113 reconstruction
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    115 results
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    117 rupture
    118 scores
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