Bilateral patellar tendon reconstruction using LARS ligaments: case report and review of the literature

Abstract

BackgroundAcute bilateral patellar tendon rupture is a rare occurrence, with only 1 case reported in the English literature of a young, fit athlete with no regular medications. To our knowledge this is the first such case reported using a LARS reconstruction.Case presentationA 26-year-old otherwise well ex-olympic gymnast with bilateral acute on chronic patellar tendon rupture underwent reconstruction using LARS ligaments. At four years post-operatively he has maintained full range of motion and strength, without re-rupture or any evidence of synovitis.ConclusionThe use of LARS ligament for reconstruction of the patellar tendon is a viable and effective option for rupture. It avoids donor site morbidity associated with autograft. Reconstruction of both patellar tendons simultaneously in a young, elite-level athlete has not previously been reported in the English-language literature.

A Suture Anchor–Based Repair Plus Reconstruction Using Acellular Human Dermal Allograft for Recurrent Sports-Related Patellar Tendon Rupture

“…Alternatively, reconstruction with allograft or synthetic materials such as allograft bone patellar bone, allograft Achilles tendon, or LARS (Ligament Augmentation and Reconstruction System) ligament have been advocated by some surgeons. 6 , 7 , 15 , 17 These options avoid donor-site morbidity and may improve mechanical properties of the surgical reconstruction, permitting early mobilization and rehabilitation, but entail potential risks of tissue rejection, infection, and/or foreign-body inflammatory reaction.…”

“…Acellular human dermal allograft is an extracellular matrix that has been used successfully in the treatment of chronic tears involving the pectoralis major, Achilles, distal biceps, and rotator cuff tendons. 5 , 6 , 7 , 8 The dermal allograft can offer mechanical support as well as improve healing by influencing host cell infiltration. 16 Clinically, there is evidence that its use is associated with a reduction in the risk of reinjury after tendon repair.…”

“…Previous literature on chronic ruptures has described reconstructive techniques that include the use of autograft or allograft tendon, acellular human dermal allograft, and synthetic materials. 5 , 6 , 7 However, there is no gold standard for these challenging cases. Acellular human dermal allograft has been used with success in reinforcing tendon repairs including distal biceps, patella, quadriceps, Achilles, and rotator cuff.…”

Patellar Tendon Reconstruction Using Hamstring Tendon and Adjustable Suspensory Cortical Fixation

“…Several alternative techniques have been reported, but no large series exist and late treatment of patellar tendon rupture is still controversial. Contralateral bone-tendon-bone graft, 5 ipsilateral gracilis and semitendinosus graft,1, 6 artificial ligament,7, 8 and allograft9, 10 have been described for this surgical procedure. The influence of graft choice on knee function has not been evaluated.…”

Iterative Rupture of the Patellar Tendon: A Case Report of an Original Technique for Revision Reconstruction Using an Adjustable Loop and an Artificial Ligament

“…We therefore decided to use an artificial ligament which was passed above the patella to avoid fragilizing it even more. Artificial ligaments have already been used to reconstruct chronic extensor mechanism rupture, and Talia and Tran described a technique with the same device (LARS®) to reinforce the patellar tendon reconstruction with a good functional outcome, a range of motion of 0–130°, and no sign of synovitis [ 12 ]. They did not use any graft to reinforce the reconstruction.…”