Clinical Experience and Early Results of Carbon Fiber Augmentation of Anterior Cruciate Reconstruction of the Knee

Strum, G M; Larson, Robert L.

doi:10.1097/00003086-198506000-00018

Cited by 21 publications

(2 citation statements)

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“…The early synthetic ligament devices introduced in the 1970s yielded poor clinical results with a high percentage of mechanical failures and secondary complications including synovitis and premature arthritis [2, 4, 6, 9, 12, 19–21, 23, 29, 34, 36, 37, 42, 43]. These complications occurred in ligament substituting devices of varying materials including carbon fibre, dacron and gore‐tex and the same poor results were reported in the biological tissue augmentation devices, most of which were constructed of polyethylene [2, 4, 6, 9, 12, 19–21, 23, 29, 34, 36, 39, 42, 43]. By the early 1990s, the majority of orthopaedic surgeons had ceased use of artificial ligaments.…”

Section: Introductionmentioning

confidence: 99%

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

Tulloch

Devitt

Porter

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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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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Section: Introductionmentioning

confidence: 99%

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

Tulloch

Devitt

Porter

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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“…However, under intra-articular conditions the tissue invasion into the prosthesis was poor [21,22,28]. Carbon implants were also used as an augmentation device for autogenous reconstruction [34], but later no statistical benefit of its use was noted [13,30]. Histologically, the carbon fibre autogenous tissue composites deviated greatly from the structure of the natural ligaments [9, 21,221. These disappointments concerning tissue invasion led to the use of carbon fibres as a permanent prosthesis.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of the anterior cruciate ligament with carbon fibres: unsatisfactory results after 8 years

Mäkisalo¹,

Visuri

Viljanen

et al. 1996

Knee Surg, Sports traumatol, Arthroscopy

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A total of 37 patients were operated on for anterior cruciate ligament (ACL) insufficiency between 1980 and 1989 using two types of carbon fibre ligament substitutes. The average age of the population was 23.6 years. The carbon fibre prostheses were covered with either a strip of medial joint capsule or lyophilized dura. Follow-up averaged 8.1 years (range 4-13 years), most of the operations being done from 1983 to 1985. Evaluation included a questionnaire, physical examination, Lysholm scoring, radiographs and cruciometer testing. The operated ACLs were looser than those in the contralateral healthy knees. The Lysholm scoring system gave acceptable results (excellent and good) in 43.5%, fair in 31.4% and poor in 24.1% of cases. Acceptable results provided better stability and muscle strength. During the follow-up there was an evident deterioration in stability as well as in Lysholm score. The results between the two types of ligaments did not become statistically different. Osteoarthrosis increased in all the knees examined radiographically (28/37). The results indicate that the ACL reconstructions using these types of carbon fibre prostheses lead to unacceptable results in the long-term follow-up.

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Method for setting total graft force and load sharing in augmented ACL grafts

Lew

Engebretsen

Lewis

et al. 1990

Journal Orthopaedic Research

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The objective of this study was to develop a method for obtaining a controllable and reproducible immediate postoperative mechanical state in a knee with an anterior cruciate ligament (ACL) reconstruction. This method, called the force-setting technique, was demonstrated using a composite graft consisting of the middle third of the patellar tendon with bone blocks (PT) and the ligament augmentation device (LAD). The total graft force was set to match the force in the intact ACL at 30 degrees flexion with the knee under the same standardized external load, while at the same time the load sharing between the biologic and augmentation components was controlled. The total graft force was set to match the ACL force three separate times in each knee, with ratios of load sharing set at the following levels: 50% PT-50% LAD, 25% PT-75% LAD, and 75% PT-25% LAD. ACL, PT, LAD, and collateral forces were measured using buckle transducers, and three-dimensional knee motion was measured using an instrumented spatial linkage as 90 N anteriorly directed tibial loads were applied to eight specimens at 0 degree, 30 degrees, 60 degrees, and 90 degrees flexion with an intact ACL, an excised ACL, and the three load-sharing reconstruction states. The total graft force could be consistently set to within an average of 2% of the intact ACL force at 30 degrees flexion, and load sharing between the graft segments could be set to within an average of 5.1% of the desired ratio at 30 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)

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Clinical Experience and Early Results of Carbon Fiber Augmentation of Anterior Cruciate Reconstruction of the Knee

Cited by 21 publications

References 0 publications

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

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

Reconstruction of the anterior cruciate ligament with carbon fibres: unsatisfactory results after 8 years

Method for setting total graft force and load sharing in augmented ACL grafts

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