Anterior Cruciate Ligament Reconstruction with LARS Artificial Ligament—Clinical Results after a Long-Term Follow-Up

Parchi, Paolo Domenico; Ciapini, Gianluca; Paglialunga, Carlo; Giuntoli, Michele; Picece, Carmine; Chiellini, Fabio; Lisanti, Michele; Scaglione, Michelangelo

doi:10.1055/s-0038-1653950

Cited by 36 publications

(29 citation statements)

References 24 publications

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“…Ligament Advanced Reinforcement System (LARS ligament) and Kennedy ligament augmentation device (Kennedy LAD) are examples of artificial allograft commonly used in ACL tissue reconstruction with improved knee stability and full weight bearing documented [65]. LARS ligament are made from polyethylene terephthalate (PET) fibers that are separated into 2 compartments; an intraosseous segment with longitudinal fibers bound together by a transverse knitted structure and an intra-articular segment with parallel longitudinal fibers twisted at 90°which support growth of surrounding tissue [66]. Kennedy LAD is a cylindrical prosthesis made of braided polypropylene [67].…”

Section: Tissue Graftingmentioning

confidence: 99%

Current Progress in Tendon and Ligament Tissue Engineering

Lim

Liau

et al. 2019

Tissue Eng Regen Med

153

146

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BACKGROUND: Tendon and ligament injuries accounted for 30% of all musculoskeletal consultations with 4 million new incidences worldwide each year and thus imposed a significant burden to the society and the economy. Damaged tendon and ligament can severely affect the normal body movement and might lead to many complications if not treated promptly and adequately. Current conventional treatment through surgical repair and tissue graft are ineffective with a high rate of recurrence. METHODS: In this review, we first discussed the anatomy, physiology and pathophysiology of tendon and ligament injuries and its current treatment. Secondly, we explored the current role of tendon and ligament tissue engineering, describing its recent advances. After that, we also described stem cell and cell secreted product approaches in tendon and ligament injuries. Lastly, we examined the role of the bioreactor and mechanical loading in in vitro maturation of engineered tendon and ligament. RESULTS: Tissue engineering offers various alternative ways of treatment from biological tissue constructs to stem cell therapy and cell secreted products. Bioreactor with mechanical stimulation is instrumental in preparing mature engineered tendon and ligament substitutes in vitro. CONCLUSIONS: Tissue engineering showed great promise in replacing the damaged tendon and ligament. However, more study is needed to develop ideal engineered tendon and ligament.

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Section: Tissue Graftingmentioning

confidence: 99%

Current Progress in Tendon and Ligament Tissue Engineering

Lim

Liau

et al. 2019

Tissue Eng Regen Med

153

146

View full text Add to dashboard Cite

show abstract

“…In contrast to traditional ACL reconstruction techniques, the LARS surgical technique reduces trauma to the soft tissues of the knee with less surgical time [10,11]. Although the LARS has made achievements in the short term, serious complications have been reported, such as graft rupture, foreign-body inflammation, and serious knee synovitis [12][13][14].…”

Section: Discussionmentioning

confidence: 99%

A case report of traumatic osteoarthritis associated with LARS artificial ligament use in anterior cruciate ligament reconstruction

Dai

Wang

et al. 2020

BMC Musculoskelet Disord

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Background A ligament advanced reinforcement system (LARS) artificial ligament has been proposed for use in anterior cruciate ligament (ACL) reconstruction, and many reports have shown its success in ACL reconstruction. However, there are great concerns about the potential risk of complications, which might prevent its extensive use. Late failure may occur due to serious complications. Case presentation We report a rare case of serious osteoarthritis that occurred 2 years postoperatively in a 51-year-old man who underwent reconstruction with an LARS artificial ligament. In X-rays, the tibial tunnel was placed too posteriorly. MRI showed that the tibial tunnel was enlarged, and there was a large effusion in the knee joint. The LARS device was rough and worn. Histologically, a large number of fibroblasts and a few multinucleated giant cells infiltrated the graft fibres. Conclusion Our findings remind surgeons that an LARS device should be with great caution in ACL reconstruction.

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“…The angles between the femoral tunnel axis and the sagittal and coronal planes were 45°and 25°, respectively, and the angles between the tibial tunnel axis and the transverse and sagittal planes were 55°and 30°, respectively. The ACL graft was modeled as cylindrical to simulate a LARS graft (LARS Company, Arc sur Tille, France), which is the most popular artificial ACL graft on the market [14]. A LARS 120fiber graft was simulated and the corresponding diameter of the bone tunnel was 7.5 mm.…”

Section: Evaluation Of Biomechanical Function Of the Protection Linermentioning

confidence: 99%

A novel protection liner to improve graft-tunnel interaction following anterior cruciate ligament reconstruction: a finite element analysis

2020

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Background: Deteriorated bone-graft interaction at the tunnel entrance following ACL reconstruction (ACLR) is considered one of the primary causes of long-term tunnel enlargement and graft wear. Methods have been introduced to improve the long-term outcome, such as novel graft materials or alternative fixation methods, but have been met with varying degrees of success. This study aims to design a protection liner to improve the bonegraft interaction at the tunnel entrances. Methods: A finite element model of a human cadaveric knee was used to simulate traditional ACLR and ACLR using the protection liner. Stress distribution around the tunnel entrances and on the ACL graft were calculated under a combined loading of 103 N anterior tibial load, 7.5 Nm internal tibial moment, and 6.9 Nm valgus tibial moment at a joint flexion angle of 20°. Results were compared between the traditional ACLR and ACLR using a double liner (femoral and tibial) setup, as well as between the ACLR using a double liner setup and a single liner (femoral side) setup. Different materials (PEEK, Ti-6Al-4V, CoCrMo) for the liner were also evaluated. Results: The traditional ACLR resulted in concentrated stress on the graft where it contacted the tunnel entrance. Correspondingly, there were stress concentrations at the distal posterior zone of the femoral tunnel entrance and medial posterior zone of the tibial tunnel entrance, while the other zones suffered from a stress reduction. Use of the protection liner reduced the stress concentration around the tunnel entrances by up to 89% and increased the stress at the unloaded zones by up to 106%. Also, stress concentration on the graft was slightly decreased (15.4 vs 15.1 MPa) after using the liner. The single liner setup increased the stress concentration around the tibial tunnel entrance. Stiffer materials improved the stress distribution around tunnel entrances but had little effect on the stress on the graft. Conclusions: The novel protection liner can improve the stress distribution on the graft and at the tunnel entrances, which may be beneficial for improving the clinical outcome of ACLR.

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Anterior Cruciate Ligament Reconstruction with LARS Artificial Ligament—Clinical Results after a Long-Term Follow-Up

Cited by 36 publications

References 24 publications

Current Progress in Tendon and Ligament Tissue Engineering

Current Progress in Tendon and Ligament Tissue Engineering

A case report of traumatic osteoarthritis associated with LARS artificial ligament use in anterior cruciate ligament reconstruction

A novel protection liner to improve graft-tunnel interaction following anterior cruciate ligament reconstruction: a finite element analysis

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