Long-term outcomes of surgery using the Ligament Advanced Reinforcement System as treatment for anterior cruciate ligament tears

Abstract

Aims The aim of this prospective study was to assess the long-term clinical, radiological, functional, and quality of life (QoL)-related outcome of patients treated with the synthetic Ligament Advanced Reinforcement System (LARS) device for anterior cruciate ligament (ACL) rupture. Methods A total of 41 patients who underwent ACL reconstruction with the LARS device (mean age 39.8 years (SD 12.1 ); 32% females (n = 13)) were prospectively included between August 2001 and March 2005. MRI scans and radiographs were performed at a median follow-up of 2.0 years (interquartile range (IQR) 1.3 to 3.0; n = 40) and 12.8 years (IQR 12.1 to 13.8; n = 22). Functional and QoL-related outcome was assessed in 29 patients at a median follow-up of 12.8 years (IQR 12.0 to 14.0) and clinically reconfirmed at latest median follow-up of 16.5 years (IQR 15.5 to 17.9). International Knee Documentation Committee (IKDC) and Tegner scores were obtained pre- and postoperatively, and Lysholm score postoperatively only. At latest follow-up, range of motion, knee stability tests, 36-Item Short Form Health Survey (SF-36), and IKDC scores were ascertained. Complications and reoperations during follow-up were documented. Results Cumulative complication rate was 66% (n = 27), with 11 developing within one year from surgery and 16 after one year (including five patients with both early and late complications). Ten graft failures (24%) and eight cases of reactive synovitis were observed (20%). All 11 patients with early complications and ten with late complications underwent reoperation (including five with another surgical procedure for early complications), amounting to a cumulative reoperation rate of 51% (n = 21). Revision ACL reconstruction was performed in one patient (2.4%). Median IKDC at latest follow-up was 89.7 (IQR 78.2 to 93.1), being significantly worse in the event of previous complications. Lachman test was positive in 56% (n = 15) of reconstructed knees. All norm-based SF-36 items were at or above median at latest follow-up, and did not differ depending on development of complications. Conclusion Despite good functional and QoL-related results in the long term, the cumulative complication rate of 66%, including graft failures and reactive synovitis, has to be viewed with great concern. Cite this article: Bone Joint J 2022;104-B(2):242–248.

Is the die cast? Anterior cruciate ligament injury and osteoarthritis

“…This needs to be considered against the fact that these complications were seen in a relatively older group of patients, and that there might be an even more significant problem or a higher failure rate when these materials are used in younger, more active patients. 1 The importance of the ACL is such that many research workers are looking at preserving it in arthroplasty of the knee, either through the use of compartmental arthroplasty, [3][4][5][6][7][8] or through bicruciateretaining total knee arthroplasty (TKA). [9][10][11][12][13][14] Rupture of the ACL was initially described by Robert Adams in 1837, and the first ACL repair was reported by Mayo Robson of Leeds in 1895.…”

“…A recent paper by Smolle et al 1 in The Bone & Joint Journal highlighted quite how much variation there still is in the management and outcome of patients with an anterior cruciate ligament (ACL) injury. Although synthetic reconstruction avoids the trauma of donor site harvest and the potential complications related to allografts and xenografts, it introduces another generation of complications.…”

“…Reconstructive techniques have evolved during the past 60 years through anteromedial bundle reconstruction, double-bundle reconstruction, and an 'all-inside' technique, to more recent biological or synthetic augmentation with preservation of the ACL remnant. 1,[18][19][20][21][22] Computer-assisted navigation in ACL reconstruction, with the aim of improving the position of the tunnels and improving rotatory stability, is a goal for some techniques. 23,24 These have helped patients to regain a stable knee and return to sports.…”

“…This study was carried out well over a decade ago, and since then some countries have seen a resurgence in the use of synthetic materials to allow athletes to return to sport early. 2 The study by Smolle et al 1 emphasized the possible excellent functional results that can be obtained with these materials, while also highlighting a high complication rate. This needs to be considered against the fact that these complications were seen in a relatively older group of patients, and that there might be an even more significant problem or a higher failure rate when these materials are used in younger, more active patients.…”

“…This needs to be considered against the fact that these complications were seen in a relatively older group of patients, and that there might be an even more significant problem or a higher failure rate when these materials are used in younger, more active patients. 1…”