Arthroscopic single-bundle posterior cruciate ligament reconstruction: retrospective review of hamstring tendon graft versus LARS artificial ligament

Functional and MRI results after a 7.5 year follow-up of 35 single-stage ACL and PCL reconstructions using gracilis and semitendinosus tendon grafts and LARS artificial ligaments

PURPOSE

The aim of this study was to evaluate the long-term functional and MRI results of 35 patients who underwent bicruciate ligament reconstruction combining an ACL autograft using the gracilis and semitendinosus tendons and double-bundle PCL reconstruction using the LARS artificial ligament.

METHODS

The outcomes were measured using the Lysholm score, the Tegner activity level scale and the International Knee Documentation Committee form (IKDC 2000). KT-1000 was used to assess the clinical anterior knee laxity. Radiographs and Magnetic Resonance Imaging (MRI) was used to evaluate osteoarthritis, the continuity and integrity of ACL autograft and LARS.

RESULTS

This retrospective study examined 35 patients who underwent single-stage bicruciate ligament reconstruction between May 2005 and January 2017 with a follow-up period ranging from 3 to 15 years (a mean of 7.5 years). The mean Lysholm score was 74, mean IKDC 2000 was 71. There was a statistically significant difference with a higher Lysholm score (78.9) in early versus delayed surgical intervention (p = 0.023). Using the Kellgren Lawrence osteoarthritis classification system, radiographic findings showed stage II or III in 83% of the sample population. The MRI results revealed a rupture rate of 22% of the anterior autografted ligament and 28% of the posterior LARS artificial ligament. However, there were no long-term artificial ligament-induced complications. There was no correlation between artificial ligament rupture and poor functional results (Lysholm < 65).

CONCLUSION

The results of this study with a mean follow-up of 7.5 years show satisfactory functional scores considering the initial trauma. It seems reasonable to propose early surgical treatment with double reconstruction of the cruciate ligaments within the first 21 days of the trauma. Post-traumatic osteoarthritis is inevitable in multi-ligament knee injuries despite anatomical reconstruction. The use of a LARS artificial ligament appears to be a valid alternative for PCL reconstruction in the context of multi-ligament injury and in the absence of sufficient autologous transplants.

Association Between Tunnel Position, Tunnel Angle, Graft Signal Intensity, and Graft Thickness in the Reconstructed Posterior Cruciate Ligament

Background

An appropriate tunnel position, tunnel angle, and tunnel-graft angle are important factors for maintaining the stability and mechanical properties of a posterior cruciate ligament (PCL) graft.

Purpose

To evaluate the association between tunnel position, tunnel angle, graft signal intensity ratio (SIR), and graft thickness after remnant-preserving PCL reconstruction.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

Included were patients who had undergone remnant-preserving single-bundle PCL reconstruction using a tibialis anterior allograft between March 2014 and September 2020 and who had minimum 12-month postoperative magnetic resonance imaging scans. Tunnel position and angle were evaluated via 3-dimensional computed tomography, and their association with graft SIR on both the femoral and the tibial sides was determined. Graft thickness and SIR at 3 areas of the graft were evaluated and compared, and their association with tunnel-graft angle was also determined.

Results

Overall, 50 knees (50 patients; 43 male, 7 female) were included. The mean time to postoperative magnetic resonance imaging was 25.8 ± 15.8 months. The mean SIR of the graft's midportion was higher compared with that of the proximal and distal portions (P = .028 and P < .001, respectively), and the SIR of the proximal portion was higher compared with that of the distal portion (P = .002). The femoral tunnel-graft angle was more acute than the tibial tunnel-graft angle (P = .004). A more anteriorly and distally located femoral tunnel led to a less acute femoral tunnel-graft angle (P = .005) and a decreased SIR of the proximal portion (P = .040), and a more laterally located tibial tunnel was associated with a less acute tibial tunnel-graft angle (P = .024) and a reduced SIR of the distal portion (P = .044). The mean thicknesses of the graft's midportion and distal portion were larger than that of the proximal portion (P < .001). The SIR of the graft's midportion was positively correlated with its thickness (r = 0.321; P = .023).

Conclusion

The SIR of the proximal portion of the graft around the femoral tunnel was higher than that of the distal portion around the tibial tunnel. An anteriorly and distally positioned femoral tunnel and a laterally positioned tibial tunnel resulted in less acute tunnel-graft angles that were associated with decreased signal intensity.

Ligament Advanced Reinforcement System (LARS) synthetic graft for PCL reconstruction: systematic review and meta-analysis

INTRODUCTION

Several strategies are available for posterior cruciate ligament (PCL) reconstruction.

SOURCE OF DATA

Recently published literature in PubMed, Google Scholar and Embase databases.

AREAS OF AGREEMENT

The Ligament Advanced Reinforcement System (LARS) is a scaffold type artificial ligament, which has been widely used for ligament reconstruction of the knee.

AREAS OF CONTROVERSY

Current evidence on the reliability and feasibility of LARS for primary isolated PCL reconstruction is limited.

GROWING POINTS

The primary outcome of interest of the present work was to investigate the outcomes of PCL reconstruction using the LARS. The secondary outcome of interest was to compare the LARS versus four-strand hamstring tendon (4SHT) autograft for PCL reconstruction.

AREAS TIMELY FOR DEVELOPING RESEARCH

LARS for primary isolated PCL reconstruction seems to be effective and safe, with results comparable to the 4SHT autograft.

Hamstring, bone-patellar tendon-bone, quadriceps and peroneus longus tendon autografts for primary isolated posterior cruciate ligament reconstruction: a systematic review

INTRODUCTION

Several autografts are available to reconstruct the posterior cruciate ligament (PCL).

SOURCE OF DATA

Current scientific literature published in PubMed, Google scholar, Embase and Scopus.

AREAS OF AGREEMENT

Hamstring, bone-patellar tendon-bone (BPTB), quadriceps and peroneus longus (PLT) are the most common tendon autografts used for primary isolated PCL reconstruction.

AREAS OF CONTROVERSY

The optimal tendon source for PCL reconstruction remains nevertheless debated. Identifying the most suitable tendon autograft could assist the surgeon during primary PCL reconstruction.

GROWING POINTS

The present study compared the outcome of PCL reconstruction using hamstring, BPTB, quadriceps and PLT autografts. The focus was on patient-reported outcome measures (PROMs), joint laxity, range of motion and complications.

AREAS TIMELY FOR DEVELOPING RESEARCH

All autografts are viable options for PCL reconstruction, with BTB and hamstring autografts demonstrating superior PROMs. However, further clinical investigations are required to determine the ideal autograft construct.

Arthroscopic Reconstruction of the Posterior Cruciate Ligament with a Ligament-advanced Reinforcement System and Hamstring Tendon Autograft: A Retrospective Study

OBJECTIVE

Both ligament-advanced reinforcement system (LARS) and hamstring tendon autograft can serve as grafts for posterior cruciate ligament (PCL) reconstruction. However, few studies have compared the effectiveness of these two approaches. This study therefore aimed to compare the clinical efficacy of arthroscopic reconstruction of the PCL using either the LARS or hamstring tendon autograft.

METHODS

A total of 36 patients who underwent PCL reconstruction were retrospectively analyzed. Within this cohort, 15 patients received a reconstruction using the LARS (LARS group) and 21 using the hamstring tendon autograft (HT group).

RESULTS

The pre- and post-operative subjective scores and knee stability were evaluated and the patients were followed up for a period of 2 to 10.5 years (4.11±2.0 years on average). The last follow-up showed that functional scores and knee stability were significantly improved in both groups (P<0.05). Six months after operation, Lysholm scores and IKDC subjective scores were higher in the LARS group than in the HT group (P<0.05). Nonetheless, the last follow-up showed no significant differences in the functional scores or the posterior drawer test between the two groups (P>0.05). In the LARS and HT groups, 12 and 9 patients, respectively exhibited KT1000 values <3 mm, with the difference being statistically significant (P<0.05). In the HT group, the diameter of the four-strand hamstring tendon was positively correlated with height (P<0.05), which was 7.37±0.52 mm in males and 6.50±0.77 mm in females (P<0.05).

CONCLUSION

Both LARS and hamstring tendon approaches achieved good efficacy for PCL reconstruction, but patients in the LARS group exhibited faster functional recovery and better knee stability in the long term. LARS is especially suitable for those who hope to resume activities as early as possible.

The use of the ligament augmentation and reconstruction system for posterior cruciate ligament reconstruction in isolated and multiligament knee injuries: A systematic review

PURPOSE

To evaluate the efficacy and safety of the Ligament Augmentation and Reconstruction System (LARS) in posterior cruciate ligament (PCL) reconstruction in isolated PCL injuries and multiligament knee injuries, analysing clinical, radiographic, and patient reported outcome measures (PROMs).

METHODS

A systematic review according to PRISMA guidelines was performed through Embase via Ovid, PubMed, and the Cochrane Library to identify studies reviewing LARS use for PCL reconstruction. The methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria.

RESULTS

From 225 results screened, 13 studies were included published between 2004 and 2020, analysing LARS use for PCL reconstruction. Mean follow-up was 21 months to 11.9 years, however only four studies had follow-up of over five years. Results in isolated PCL reconstruction utilising LARS demonstrated scores that were consistent with good function and minimal limitation in daily or sporting activities, in addition to a significant improvement in knee laxity and low complication rates. Symptomatic rupture and synovitis rates were both 1.7% in this group. LARS use in complex multiligament injuries demonstrated satisfactory PROMs, although there was concern regarding residual laxity on stress radiography.

CONCLUSIONS

LARS demonstrates good outcomes in PCL injury reconstruction in the short to mid-term, particularly in isolated PCL injuries, achieving equivocal or improved results compared to autograft reconstruction using hamstring tendon in the three comparative studies included. LARS has a quicker recovery time and no donor-site morbidity, however long-term data is lacking. Utilising LARS for reconstruction of the PCL in multiligament injuries revealed more variable results.

Quadriceps tendon autograft is an effective alternative graft for posterior cruciate ligament reconstruction in isolated or multiligament injuries: a systematic review

IMPORTANCE

High-grade posterior cruciate ligament (PCL) tears can be a significant cause of patient morbidity and knee instability. The graft of choice for operative repair remains controversial, although recently there has been increased interest in quadriceps tendon (QT) as an autologous graft option.

OBJECTIVE

The purpose of this study was to perform a systematic review to assess reported clinical outcomes of PCL reconstructions using QT autografts.

EVIDENCE REVIEW

A comprehensive review of clinical studies was performed evaluating PCL reconstruction with QT autograft including a systematic search of PubMed, Scopus, Cochrane and Google Scholar databases, and reference lists of relevant papers. Clinical results, stability results, functional outcomes, range-of-motion outcomes, complications and morbidity, and the conclusions of each study were evaluated.

FINDINGS

Seven studies were included in the review of clinical results, including 145 subjects undergoing PCL reconstructions with QT autograft. All studies evaluated quadriceps tendon bone (QT-B) grafts. Among these seven studies, two included isolated PCL reconstruction while five included multiligamentous knee injury reconstruction. These studies suggest that QT-B autograft offers a viable graft option for primary PCL reconstruction with generally favourable patient-reported outcomes, knee stability and range of motion reported along with relatively low complication rates.

CONCLUSIONS AND RELEVANCE

Use of the QT-B autograft may be a reasonable graft option for PCL reconstruction. However, high-quality prospective studies are required to evaluate the long-term safety, efficacy and functional outcomes.

LEVEL OF EVIDENCE

Level IV (Systematic review of Level IV studies).

Quadriceps or patellar ligament reconstruction with artificial ligament after total knee replacement

BACKGROUND AND AIM OF THE WORK

Ruptures of the quadriceps or patellar tendon after TKA implantation are a fearful and disabling complication. Direct reconstructions highlighted various problems, such as the decrease in extensor force, failure, need for prolonged post-operative immobilization. So augmentation techniques have been proposed with autologous tendons, allografts, artificial ligaments. Among these, the LARS seems the most modern and promising. For this reason, we have retrospectively reviewed a case series patients operated with this artificial ligament, to evaluate the results and highlight the tips and tricks for this procedure.

METHODS

Ten patients with a mean age of 69.4 years suffered an extensor apparatus lesion after knee replacement. These patients underwent primary reconstruction and augmentation with LARS. They were retrospectively reviewed at a mean follow-up of 3.8 years, by measuring active flexion and extension, and by Lysholm scoring scale.

RESULTS

We did not observe any problems with healing of the surgical wound, nor phenomena of intolerance to the implanted material, such as inflammation, skin rashes or fistulas. The mean flexion was 117 degrees. Active extension was allowed in all patients, but with a mean extensor lag of 18 degrees. The mean Lysholm score was 74.2.

CONCLUSIONS

LARS offers good results without completely solving the problem of extensor lag, linked to the softness of the tissues in the quadriceps. The major advantages of LARS reside in the good tissue ingrowth, the absence of adverse tissue reactions, the ubiquitous availability, the possibility of stable fixation with early rehabilitation.

Enhanced Biomechanical Performance of a Modern Polyester Surgical Mesh for Extensor Mechanism Reconstruction in Total Knee Arthroplasty

BACKGROUND

Extensor mechanism (EM) disruption following total knee arthroplasty is a devastating postoperative complication. Reconstruction with a synthetic mesh is one treatment option, although the optimal mesh material remains unknown. This study sought to compare the mechanical properties of 2 mesh material types that can be used for EM reconstruction.

METHODS

Mechanical properties of a polypropylene mesh (Marlex mesh) and Ligament Advanced Reinforcement System (LARS) mesh were compared using force-displacement data from a material testing machine simulating knee movement during normal human gait. Tension to failure/ultimate tensile load, stiffness coefficients, axial strain, and cyclic hysteresis testing were measured and calculated.

RESULTS

Compared to polypropylene mesh, LARS mesh demonstrated a significantly higher mean ultimate tensile load (2223 N vs 1245 N, P = .002) and stiffness coefficient (255 N/mm vs 14 N/mm, P = .035) in tension to failure testing, and significantly more energy dissipation (hysteresis) in hysteresis testing (771 kJ vs 23 kJ; P ≤ .040). LARS mesh also demonstrated significantly less maximum displacement compared to the polypropylene mesh (9.2 mm vs 90.4 mm; P ≤ .001).

CONCLUSION

Compared to polypropylene mesh, LARS mesh showed superior performance related to force-displacement testing. The enhanced mechanical performance of LARS mesh may correlate clinically to fewer failures, increased longevity, and higher resistance to plastic deformation (extensor lag). Future research should evaluate survivorship and clinical outcomes of these meshes when used for EM reconstruction.

Autografts vs Synthetics for Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis

To describe the outcomes of autografts and synthetics in anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction with respect to instrumented laxity measurements, patient‐reported outcome scores, complications, and graft failure risk. We searched PubMed, Cochrane Library, and EMBASE for published randomized controlled trials (RCT) and case controlled trials (CCTs) to compare the outcomes of the autografts versus synthetics after cruciate ligament reconstruction. Data analyses were performed using Cochrane Collaboration RevMan 5.0. Nine studies were identified from the literature review. Of these studies, three studies compared the results of bone–patellar tendon–bone (BPTB) and ligament augmentation and reconstruction system (LARS), while six studies compared the results of four‐strand hamstring tendon graft (4SHG) and LARS. The comparative study showed no difference in Lysholm score and failure risk between autografts and synthetics. The combined results of the meta‐analysis indicated that there was a significantly lower rate of side‐to‐side difference > 3 mm (Odds Ratio [OR] 2.46, 95% confidence intervals [CI] 1.44–4.22, P = 0.001), overall IKDC (OR 0.40, 95% CI 0.19–0.83, P = 0.01), complications (OR 2.54, 95% CI 1.26–5.14, P = 0.009), and Tegner score (OR −0.31, 95% CI −0.52–0.10, P = 0.004) in the synthetics group than in the autografts group. This systematic review comparing long‐term outcomes after cruciate ligament reconstruction with either autograft or synthetics suggests no significant differences in failure risk. Autografts were inferior to synthetics with respect to restoring knee joint stability and patient‐reported outcome scores, and were also associated with more postoperative complications.

LARS synthetic ligaments for the acute management of 111 acute knee dislocations: effective surgical treatment for most ligaments

PURPOSE

The purpose of this study was to describe the longitudinal outcomes of acute repair and augmentation for the reconstruction of dislocated knees, using LARS synthetic ligaments.

METHODS

Patients with a knee dislocation surgically treated using LARS synthetic ligament augmentation, with a minimum follow-up of 24 months, were enrolled between 1996 and 2014. Range of motion, Lachman, pivot shift, posterior drawer, step off sign, valgus, varus, KT-1000 arthrometer, Telos technique, IKDC, Lysholm, Tegner, and Meyers scores were obtained every 2 years up to 10 years.

RESULTS

Median age was 32.1 years (IQR 23.2-43.3) at time of surgery. Median time from trauma to surgery was 9 days and mean follow-up time was 6.6 years. Median questionnaire scores were: Lysholm 79.5 (IQR 65.0-89.0), Tegner 4.0 (IQR 3.7-6.0), Meyers 3.0 (IQR 3.0-4.0), and mean IKDC was 63.8 (SD 18.9). Median flexion and extension of the injured knee was 124° (IQR 115-129.5) and 0° (IQR - 5 to 0), respectively. Median KT-1000 differential was 0.7 mm (IQR 0.1-3.1) for ACL and 0.9 mm (IQR 0.2-1.4) for PCL. Mean differential for Telos was 2.5 mm (SD 5.8) for ACL, 4 mm (IQR 2-6.3) for PCL 30°, and 8.2 mm (SD 4.4) for PCL 90° (consistent with PCL laxity). More than 90% of patients had good anterior articular stability and > 60% of patients had good posterior articular stability.

CONCLUSIONS

Acute repair and augmentation of knee dislocations with LARS synthetic ligaments resulted in satisfactory outcomes for the ACL and collateral structures. Telos stress radiography showed PCL laxity in more than half of cases despite low laxity results with KT-1000. The perception of patients about knee function was sustained in time.

LEVEL OF EVIDENCE

IV.

Biological and Biomechanical Evaluation of Autologous Tendon Combined with Ligament Advanced Reinforcement System Artificial Ligament in a Rabbit Model of Anterior Cruciate Ligament Reconstruction

OBJECTIVE

To compare the biomechanical and histological changes in a rabbit model after reconstructing the anterior cruciate ligament (ACL) with solely autologous tendon and with autologous tendon combined with the ligament advanced reinforcement system (LARS) artificial ligament.

METHODS

Anterior cruciate ligament reconstruction was performed in 72 knees from 36 healthy New Zealand white rabbits (bodyweight, 2500-3000 g). The Achilles tendons were harvested bilaterally. The left ACL were reconstructed solely with autografts (autologous tendon group), while the right ACL were reconstructed with autografts combined with LARS ligaments (combined ligaments group). The gross observation, histological determination, and the tension failure loads in both groups were evaluated at 12 weeks (n = 18) and 24 weeks (n = 18) postoperatively.

RESULTS

Gross examination of the knee joints showed that all combined ligaments were obviously covered by a connective tissue layer at 12 weeks, and were completely covered at 24 weeks. Fibrous tissue ingrowth was observed between fascicles and individual fibers in the bone-artificial ligament interface at both time points; this fibrovascular tissue layer localized at the bone-artificial ligament interface tended to be denser in specimens obtained at 24 weeks compared with those obtained at 12 weeks. The tension failure loads of the knees were similar in the autologous tendon group and the combined ligaments group at 12 weeks (144.15 ± 3.92 N vs. 140.88 ± 2.75 N; P > 0.05), and at 24 weeks (184.15 ± 1.96 N vs. 180.88 ± 3.21 N; P > 0.05).

CONCLUSION

Reconstructing the ACL in rabbits using autologous tendon combined with the LARS artificial ligament results in satisfactory biointegration, with no obvious immunological rejection between the autologous tendon and the artificial ligament, and is, therefore, a promising ACL reconstruction method.

Optimal management of posterior cruciate ligament injuries: current perspectives

Background

The optimal management of posterior cruciate ligament (PCL) injuries is debated by orthopedic surgeons. A natural history study (NHS) of acute, isolated PCL tears in patients with a mean follow-up of 14.3 years was previously published. The purpose of this study was to compare and contrast the results of the NHS study with those of other studies with similar follow-up time after operative and nonoperative management of isolated PCL tears.

Material and methods

With reviewing the literature, six operative management and six nonoperative management studies were found for treating isolated PCL injuries. We analyzed the subjective and objective outcomes of these 12 studies and compared them to the results of the NHS to determine optimal management of PCL injuries.

Results

Final follow-up times ranged from a mean of 6.2 to 15 years in the nonoperative studies and 6.3 to 12 years in the operative studies. Side-to-side differences in laxity following surgical management ranged from 1.1 to 7 mm on KT-1000 arthrometer testing and 2.8 to 4.7 mm on Telos stress testing. Tegner scores at final follow-up ranged from 6.6 to 7.7 in nonoperative studies and 5.7 to 7.4 in operative studies. International Knee Documentation Committee scores were 73.4, 82.7, and 84 in nonoperative studies and 65 and 87 in the operative studies. Lysholm scores were 85.2 in the nonoperative study and ranged from 81 to 92.1 in operative studies. Osteoarthritis was reported with ranges from 17% to 88% in nonoperative studies and 13.3% to 63.6% in operative studies.

Conclusion

We found that the subjective and objective results in the NHS compare favorably to those of outcomes for PCL reconstruction. Unless a technique is found that can completely restore knee stability, it is unlikely that simply reducing posterior laxity will improve outcomes or prevent the development of osteoarthritis.

Prospective analysis using a patient-based health-related scale shows lower functional scores after posterior cruciate ligament reconstructions as compared with anterior cruciate ligament reconstructions of the knee

PURPOSE

This study evaluated the treatment outcome of posterior cruciate ligament (PCL) reconstruction using the Medical Outcome Study 36-item Short-Form Health Survey (SF-36), a patient-based quality of life (QOL) questionnaire comparing it with anterior cruciate ligament (ACL) reconstruction.

METHODS

Patients who underwent reconstruction at our center for PCL (n = 24) or ACL (n = 197) injury were studied. The patients were evaluated using SF-36, visual analogue scale (VAS) for knee pain, Lysholm scale, posterior or anterior tibial translation and range of motion (ROM) before surgery until 24 months after surgery. Results were compared.

RESULTS

In the ACL group, all evaluation methods showed significant improvement after surgery. In the PCL group, however, improvement was observed in only three of eight subscales of the SF-36, Lysholm score and posterior tibial translation after surgery. In intergroup comparison, the PCL group showed inferior performance in three subscales of the SF-36, Lysholm score and ROM for flexion compared with the ACL group.

CONCLUSIONS

The surgical outcome of PCL reconstruction was inferior to that of ACL reconstruction both in patient-based and conventional doctor-based assessments. An improved surgical technique for PCL is required.

Comparison of hamstring tendon autograft and tibialis anterior allograft in arthroscopic transtibial single-bundle posterior cruciate ligament reconstruction

PURPOSE

To compare the outcomes between hamstring tendon autograft and tibialis anterior allograft in arthroscopic transtibial single-bundle posterior cruciate ligament (PCL) reconstruction.

METHODS

Thirty-seven patients undergoing isolated single-bundle PCL reconstruction were enrolled in this study, and their data were retrospectively analyzed. They were divided into group A [4-strand hamstring tendon autograft (4SHG), n = 18] and group B [2-strand tibialis anterior allograft (2STAG), n = 19] and followed up for 2 years at least. Several parameters including the International Knee Documentation Committee score, Lysholm knee score, Tegner activity rating and knee laxity arthrometer were evaluated, and physical examination was performed preoperatively and postoperatively, and postoperative complications were also observed in all patients. Meanwhile, the postoperative posterior instability was compared between the affected knee and the contra-lateral knee.

RESULTS

Compared with preoperative knee laxity and function, both groups had significant improvement postoperatively (P < 0.01). However, there were no significant differences in knee laxity and function between both groups (n.s.). Compared with contra-lateral knee, the posterior stability was worse in the affected knee (P < 0.01).

CONCLUSIONS

The outcomes were similar between 4SHG or 2STAG in PCL reconstruction. Compared with contra-lateral knees, the affected knees have slight residual knee laxity in both groups.

LEVEL OF EVIDENCE

Retrospective comparative study, Level III.

Augmented short undersized hamstring tendon graft with LARS® artificial ligament versus four-strand hamstring tendon in anterior cruciate ligament reconstruction: preliminary results

BACKGROUND

This retrospective study compares the results of reconstruction of isolated chronic anterior cruciate ligament rupture using augmented short undersized sized hamstring tendon graft with ligament advanced artificial reinforcement system (LARS) versus a four-strand hamstring tendon graft (4-SHG). Our hypothesis was that postoperative knee stability after using augmented short length or small diameter hamstring tendon graft with LARS artificial ligament could be significant and satisfactory more than 4-strand hamstring tendon graft group.

MATERIALS AND METHODS

Between June 2007-July 2008, 72 patients were divided into a (LARS) augmented group (n=27) and a (4-SHG) group (n=45).

RESULTS

Mean FU is 5years. KT-1000 examinations showed that the LARS group had significantly less anterior displacement than the (4-SHG) group P=0.013. IKDC score demonstrated statistically significant differences (P=0.05).

CONCLUSIONS

Our study indicates that early results of augmenting: short length or small diameter harvested hamstring tendons with LARS in ACL reconstruction provides satisfactory, comparable results and displayed higher knee stability compared to (4-SHG) group.

LEVEL OF EVIDENCE

Level III (case control study).

Tibial tunnel aperture location during single-bundle posterior cruciate ligament reconstruction: comparison of tibial guide positions

PURPOSE

We aimed to compare posterior cruciate ligament (PCL) tibial tunnel location after tibial guide insertion medial (between the PCL remnant and the medial femoral condyle) and lateral (between the PCL remnant and the anterior cruciate ligament) to the PCL stump as determined by in vivo 3-dimensional computed tomography (3D-CT).

METHODS

Tibial tunnel aperture location was analyzed by immediate postoperative in vivo CT in 66 patients who underwent single-bundle PCL reconstruction, 31 by over-the-PCL and 35 by under-the-PCL tibial guide insertion techniques. Tibial tunnel positions were measured in the medial to lateral and proximal to distal directions of the posterior proximal tibia.

RESULTS

The center of the tibial tunnel aperture was located more laterally (by 2.7 mm) in the over-the-PCL group than in the under-the-PCL group (P = .040) and by a relative percentage (absolute value/tibial width) of 3.2% (P = .031). Tibial tunnel positions in the proximal to distal direction, determined by absolute value and relative percentage, were similar in the 2 groups.

CONCLUSIONS

Tibial tunnel apertures were located more laterally after lateral-to-the-PCL tibial guide insertion than after medial-to-the-PCL tibial guide insertion. There was, however, no significant difference between these techniques in distance from the joint line to the tibial tunnel aperture. Insertion lateral to the PCL stump may result in better placement of the PCL in its anatomic footprint.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

A comparison of acute and chronic anterior cruciate ligament reconstruction using LARS artificial ligaments: a randomized prospective study with a 5-year follow-up

PURPOSE

This prospective randomized study compared acute and chronic anterior cruciate ligament (ACL) reconstruction using ligament advanced reinforcement system (LARS) artificial ligament in young active adults with a 5-year follow-up.

METHODS

Fifty-five patients were enrolled in this study and divided into two groups based on the elapsed time between the injury and reconstruction: the acute group (3-7 weeks) and the chronic group (6-11 months). The clinical outcomes were evaluated using the Lysholm knee scoring scale, the Tegner activity rating, a KT-1000 Arthrometer, and the International Knee Documentation Committee (IKDC) scoring system. Isokinetic strength of the quadriceps and hamstring was assessed using the Biodex System 3 isokinetic dynamometer.

RESULTS

Anterior laxity was decreased and quadriceps/hamstring muscle strength was increased in the acute group compared to the chronic group (p > 0.05). There were no statistically significant differences in Lysholm scores, Tegner activity scores, and the IKDC evaluation form between the two groups.

CONCLUSIONS

These results suggest that earlier ACL reconstruction using a LARS artificial ligament may provide an advantage in the treatment and rehabilitation of ACL rupture.

Hamstring tendon autograft versus LARS artificial ligament for arthroscopic posterior cruciate ligament reconstruction in a long-term follow-up

INTRODUCTION

Surgical reconstruction has been increasingly recommended for the surgical management of posterior cruciate ligament (PCL) ruptures. While the choice of tissue graft still remains controversial. Currently both hamstring tendon autograft (HTG) and ligament advanced reinforcement system (LARS) artificial ligament are widely used but there are seldom reports on the comparisons of their clinical results. Our study was aimed to assess the effectiveness of these two grafts.

MATERIALS AND METHODS

Thirty-five patients with unilateral PCL rupture were enrolled in this retrospectively study. Sixteen of them received arthroscopically assisted PCL reconstruction using hamstring tendon autografts (HTG group) and nineteen using LARS ligaments (LARS group). All cases were followed up for 46-57 months with a mean of 51 months. Follow-up examinations included radiographic assessment, Lysholm score, Tegner score, International Knee Documentation Committee (IKDC) rating scales and KT-1000 test.

RESULTS

All patients improved significantly at the final follow-up compared with the examinational results preoperatively and there were no significant differences between HTG group and LARS group with respect to the results of radiographic assessment, Lysholm score, Tegner score, IKDC rating scales and KT-1000 test.

CONCLUSIONS

Similar good clinical results were obtained after PCL reconstruction using hamstring tendon autografts and LARS ligaments. Both LARS ligament and hamstring tendon autograft are ideal grafts for PCL reconstruction.

The predictive effect of anatomic femoral and tibial graft tunnel placement in posterior cruciate ligament reconstruction on functional and radiological outcome

PURPOSE

Biomechanical reports have advocated anatomic graft tunnel placement for reconstruction of the posterior cruciate ligament (PCL) to restore knee joint stability and facilitate optimal functional outcome. However, in vivo investigations that correlate tunnel position to functional results are lacking so far. This study evaluates the anatomic accuracy of femoral and tibial tunnel apertures on postoperative computed tomography (CT) scans and compares these findings to subjective and objective clinical outcome parameters.

METHODS

After single-bundle PCL reconstruction, 29 patients were stratified into several subgroups according to the anatomic accuracy of femoral and tibial tunnel apertures measured on postoperative CT scans. A threshold value for the centres of the tunnel apertures was determined using a measurement grid system as a radiographic reference. To evaluate the functional and radiological results, visual analogue scale, International Knee Documentation Committee (IKDC), Tegner, Lysholm, Knee Injury and Osteoarthritis Outcome Score and osteoarthritis scores were obtained.

RESULTS

Comparison between functional outcome and tunnel position yielded a statistically significant difference for subjective IKDC score and angle segment α and for objective stability and tunnel position P3 but no statistically significant difference with respect to intercondylar depth, intercondylar height and tibial tunnel position P2. No correlation was found between anatomic tunnel position and present or progressive osteoarthritis on follow-up. Of the patients, 72 % classified their result as excellent and good and 90 % would repeat surgical treatment.

CONCLUSIONS

Despite a small sample size and subject to the threshold values we used, our data indicate a potentially minor effect of anatomic tunnel placement on midterm functional outcome following PCL reconstruction.

Biomedical coatings on polyethylene terephthalate artificial ligaments

This review comprehensively covers research conducted to enhance polyethylene terephthalate (PET) artificial ligament osseointegration in the bone tunnel. These strategies, using biocompatible or bioactive coatings, had a positive effect in promoting PET ligament osseointegration by increasing bone formation and decreasing fibrous scar tissue at the ligament-to-bone interface. The improved osseointegration can be translated into a significant increase in the biomechanical pull-out loads. However, the load-to-failure of coated ligament is far lower than that of native ACL. Coatings to promote intra-articular ligamentization are also discussed in this study. Collectively, our investigations may arouse further study of the biological coating of PET artificial ligaments in order to effectively enhance ligament osseointegration and promote artificial ligament ligamentization.

Tibial tunnel placement in posterior cruciate ligament reconstruction: a systematic review

PURPOSE

Reconstruction of the posterior cruciate ligament (PCL) yields less satisfying results than anterior cruciate ligament reconstruction with respect to laxity control. Accurate tibial tunnel placement is crucial for successful PCL reconstruction using arthroscopic tibial tunnel techniques. A discrepancy between anatomical studies of the tibial PCL insertion site and surgical recommendations for tibial tunnel placement remains. The objective of this study was to identify the optimal placement of the tibial tunnel in PCL reconstruction based on clinical studies.

METHODS

In a systematic review of the literature, MEDLINE, EMBASE, Cochrane Review, and Cochrane Central Register of Controlled Trials were screened for articles about PCL reconstruction from January 1990 to September 2011. Clinical trials comparing at least two PCL reconstruction techniques were extracted and independently analysed by each author. Only studies comparing different tibial tunnel placements in the retrospinal area were included.

RESULTS

This systematic review found no comparative clinical trial for tibial tunnel placement in PCL reconstruction. Several anatomical, radiological, and biomechanical studies have described the tibial insertion sites of the native PCL and have led to recommendations for placement of the tibial tunnel outlet in the retrospinal area. However, surgical recommendations and the results of morphological studies are often contradictory.

CONCLUSIONS

Reliable anatomical landmarks for tunnel placement are lacking. Future randomized controlled trials could compare precisely defined tibial tunnel placements in PCL reconstruction, which would require an established mapping of the retrospinal area of the tibial plateau with defined anatomical and radiological landmarks.

The use of the ligament augmentation and reconstruction system (LARS) for posterior cruciate reconstruction

PURPOSE

To systematically review and assess the use of the Ligament Advanced Reinforcement System (LARS; Surgical Implants and Devices, Arc-sur-Tille, France) for posterior cruciate ligament (PCL) reconstruction.

METHODS

A search of multiple databases was conducted using the following terms: (LARS[All Fields] AND posterior[All Fields]) OR (LARS[All Fields] AND PCL[All Fields]). The methodologic quality of each article was assessed by use of abridged Downs and Black criteria.

RESULTS

Fifty-four studies were found from the database search, of which 5 were included in the final review (4 case series and 1 case-control study). One hundred twenty-nine PCL reconstructions with LARS were performed. The mean patient age was 32.2 years, with 89 male and 40 female patients included. The mean follow-up time ranged from 10.5 to 44 months. Lysholm scores improved from a mean of 64.8 preoperatively to 89.8 postoperatively. No patients had International Knee Documentation Committee grade 1 or 2 preoperatively, with 93.0% achieving this postoperatively. Only 1 case of synovitis and 1 case of graft rupture were reported.

CONCLUSIONS

There is little evidence on the effectiveness of PCL reconstructions using LARS ligaments. What data there are show great promise, with short- and medium-term outcome data appearing favorable to autograft reconstruction. Complication rates are encouragingly low.

CLINICAL RELEVANCE

LARS has great potential for PCL reconstruction. Further studies are needed regarding the use of LARS ligaments during PCL reconstruction, including longer follow-up periods and investigation into the optimal timing for reconstruction. This may be best achieved by way of a multicenter study.

Rehabilitation after posterior cruciate ligament reconstruction: a review of the literature and theoretical support

INTRODUCTION

The purpose of this study was to conduct a literature review of studies that have addressed rehabilitation after posterior cruciate ligament (PCL) reconstruction. In particular, we intended to perform categorical analysis and discuss some critical points.

MATERIALS AND METHODS

A literature review of English language articles was performed using the PubMed databases. Our literature search was performed using the following text words: [posterior cruciate ligament OR PCL] AND [reconstruction] AND [rehabilitation]. A total of 34 articles met our criteria and were included in the final systematic review. Rehabilitation protocols were reviewed and tabulated according to main rehabilitation protocol categories [range of motion (ROM), weight bearing, bracing, and strengthening].

RESULTS

Ranges of motion of 90° and 120° were allowed at 4-8 and 6-12 weeks postoperatively in 70 % of studies. Full weight bearing was delayed until 6 weeks postoperatively in 60 % of studies. Most studies (73 % of studies) used a brace for 6-8 weeks and active hamstring exercise was not allowed for 6-24 weeks postoperatively.

CONCLUSIONS

The review showed that flexion of 90° was allowed at around 6 weeks and prone passive flexion exercise or supine passive ROM exercise with posterior support was used to prevent a posteriorly directed force. Most authors used non-weight bearing or partial weight bearing in their rehabilitation programs, however it may be possible to perform active weight bearing in full extension or early flexion grades as soon as the soft tissue situation allows. Co-strengthening exercises could be recommended because these exercises produce co-contraction between the quadriceps and hamstring muscles with little posterior shear force.

Minimum 10-year follow-up of patients after an acute, isolated posterior cruciate ligament injury treated nonoperatively

BACKGROUND

Few studies report long-term subjective or objective results for acute, isolated posterior cruciate ligament (PCL) injuries in patients followed prospectively.

HYPOTHESIS

Subjective or objective results will not differ based on PCL laxity.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Sixty-eight patients with an acute, isolated PCL injury were treated nonoperatively and followed prospectively with yearly subjective surveys and periodic objective evaluations. Physical examination included evaluation of range of motion, effusion, and quadriceps strength; radiographic grading of osteoarthritis; and measurements of joint space width. Subjective follow-up included the International Knee Documentation Committee (IKDC) and modified Cincinnati Knee Rating System (CKRS) surveys.

RESULTS

A total of 44 patients were available for both objective and subjective evaluations at a mean of 14.3 years (range, 10-21 years) after injury. All 68 patients underwent subjective follow-up at a mean of 17.6 years after injury. The mean quadriceps muscle strength was 97% of the noninvolved leg; all patients maintained normal knee range of motion. The overall grade of radiographs was rated as normal in 26 patients (59%), nearly normal in 13 patients (30%), abnormal in 4 patients (9%), and severely abnormal in 1 patient (2%). The grade of osteoarthritis on radiographs was not different in any knee compartment based on PCL laxity grade. Five patients (11%) had medial joint space narrowing greater than 2 mm. Mean IKDC and modified CKRS subjective scores at a mean of 17 years after injury were 73.4 ± 21.7 and 81.3 ± 17.4, respectively; there was no difference in subjective scores between PCL laxity grades. There was no difference in subjective scores between patients who completed a minimum 10-year objective follow-up and patients who completed surveys only.

CONCLUSION

Long-term results after an isolated PCL injury show that patients remain active, have good strength and full knee range of motion, and report good subjective scores. The prevalence of moderate to severe osteoarthritis was 11%. Results were not different based on PCL laxity grade. This natural history study of nonoperatively treated PCL injuries can serve as a baseline for comparison with patients treated with PCL reconstruction.

Anterior cruciate ligament reconstruction with LARS™ artificial ligament results at a mean follow-up of eight years

PURPOSE

The aim of this study was to review patients that underwent ACL reconstruction with the LARS™ ligament in the First Orthopaedic Division of Pisa University during the period between January 2003 and December 2005.

METHODS

Twenty-six patients were reviewed with an average follow-up of 95.3 months (7.9 years). The review protocol was articulated in three phases: (1) a subjective evaluation using three grading scales: VAS, KOOS and the Cincinnati knee rating scale, (2) a clinical and objective evaluation, and (3) a biomechanical evaluation of the knee stability.

RESULTS

A global positive result was obtained in 92.3 % of the patients (16 optimal results and eight good results), with a fast functional recovery and a high knee stability. A global poor result was reported in two cases. In our series we did not record cases of infection or knee synovitis. We recorded only one case of mechanical graft failure. The results obtained from our study are encouraging and similar to those in the literature.

CONCLUSIONS

We conclude that the LARS™ ligament can be considered a suitable option for ACL reconstruction in carefully selected cases, especially for older patients needing a fast functional recovery.

The use of Ligament Advanced Reinforcement System (LARS) in limb salvage surgery: a pilot clinical study

The aims of this study were to analyze the preliminary clinical outcome of limb salvage using Ligament Advanced Reinforcement System (LARS). It is hypothesized that LARS ligament is a safe and effective choice to enhance prosthetic reconstructions, providing good muscles reattachment and improving joint stability. From March 2009 to March 2010, 7 patients received megaprosthesis reconstruction following tumor resection in combination with soft tissue reconstruction using LARS. Reconstructions were four around the knee and three in proximal femur. The average MSTS 93 score was 81.0% at a mean follow-up of 27.0 months. No infection was observed. The results show that LARS appears to be an effective device for limb salvage surgery providing good muscles reattachment, improving joint stability.

Acute single-stage reconstruction of multiligament knee injuries using the ligament advanced reinforcement system

OBJECTIVE

The purpose of the study was to report our early outcome in the management of multiligament knee injuries with the ligament advanced reinforcement system (LARS).

SUBJECTS AND METHODS

Between 2007 and 2010, 9 of 11 patients operated on for multiligament knee injuries were included in this study; 2 patients were excluded due to complicated neurovascular injuries, open knee dislocations and severe comorbidities. All patients were managed acutely (<3 weeks) by reconstructions of the cruciate and collateral ligaments with LARS ligament and were followed up for an average of 30 months (18-46 months).

RESULTS

The mean Lysholm score of the 9 patients at final follow-up was around 90 (range 88-94) with an average Tegner activity score of 5.5. The postoperative function of 1 case of KD-11 and 2 cases of KD-111 was rated as 'A,' while the remaining cases were rated 'B'. At final follow-up, minor osteoarthritic degeneration was detected in 1 case of KD-III and 2 cases of KD-IV. Superficial infection developed in 1 case, and no cases of knee synovitis and premature osteoarthritis were recorded.

CONCLUSION

A creditable outcome at mean of 30 months' follow-up was obtained in acute single-stage reconstruction of uncomplicated multiligament knee injuries with LARS ligament.

Acute knee dislocation: an evidence based approach to the management of the multiligament injured knee

Traumatic knee dislocations are uncommon yet serious injuries that historically have had variable prognosis. The evaluation and management of traumatic knee dislocations remains controversial. Appropriate early management has been shown to have a significant impact on long term functional outcome. A comprehensive review of the recent literature is presented alongside our current approach to management. The dislocated knee is an under diagnosed injury which relies on a high index of clinical suspicion on presentation of any knee injury. There is now a degree of consensus regarding need for surgery, timing of surgery, vascular investigations, surgical techniques and rehabilitation protocols. Vigilant monitoring for neurovascular complications, appropriate investigations and early involvement of surgeons with a specialist interest in knee ligament surgeries is the key to successful management of these difficult injuries.

Enhancement of the osseointegration of a polyethylene terephthalate artificial ligament graft in a bone tunnel using 58S bioglass

PURPOSE

The aim of the study was to investigate whether a bioactive glass (BG) coating on the polyethylene terephthalate (PET) artificial ligament could enhance graft osseointegration by promoting bone regeneration at the interface between PET graft and bone tunnel.

METHODS

Thirty New Zealand white rabbits underwent artificial ligament graft transplantation in proximal tibial tunnels bilaterally. One limb was implanted with a 58S BG-coated PET graft, and the contralateral limb was implanted with a non-BG-coated PET graft as a control. The rabbits were randomly sacrificed at three, six and 12 weeks after surgery for biomechanical and histological examinations.

RESULTS

The maximum load to failures of the BG-coated experimental group were significantly higher than those of the control group at 12 weeks (p = 0.0051). Histologically, at 12 weeks, the BG-coated PET graft induced great new bone formation between graft and host bone, and the average graft-bone interface width of the BG group became significantly lower than that of the control group. Furthermore, the BG coating on the ligament graft surface also stimulated greater expression of bone morphogenetic protein 2 (BMP-2) and vascular endothelial growth factor (VEGF) around the graft in vivo compared to the control group at three weeks (p < 0.05).

CONCLUSIONS

This study has shown that a BG coating on the PET artificial ligament surface has a positive effect in the induction of artificial ligament osseointegration within the bone tunnel.

Clinical results of arthroscopic single-bundle transtibial posterior cruciate ligament reconstruction: a systematic review

BACKGROUND

Reconstruction of the posterior cruciate ligament has traditionally been performed using an arthroscopically assisted single-bundle transtibial technique. Unfortunately, clinical studies evaluating this procedure are rare. In addition, there are no pooled analyses evaluating the effectiveness of this procedure for isolated posterior cruciate ligament tears.

HYPOTHESIS

Patients who undergo arthroscopically assisted, single-bundle, transtibial posterior cruciate ligament reconstruction will exhibit subjective improvement in knee function despite persistent objective knee laxity.

STUDY DESIGN

Systematic review.

METHODS

A structured literature search was performed to identify those clinical studies assessing the results of an arthroscopically assisted single-bundle transtibial posterior cruciate ligament reconstruction for isolated posterior cruciate ligament tears. The published data meeting the inclusion criteria were systematically reviewed with an emphasis on residual posterior laxity, subjective and objective functional outcome, activity level, patient satisfaction, incidence of osteoarthritis, and postoperative complications.

RESULTS

A total of 10 studies were identified that met the inclusion criteria. Mean postoperative instrumented posterior knee laxity varied from 1.96 mm to 5.90 mm, which was considerably improved from preoperative values (range, 8.38-12.3 mm). The range of mean values of the Lysholm knee scores was 81 to 100 points. The overall International Knee Documentation Committee rating was categorized as "normal" or "nearly normal" in 75% of patients and the mean Tegner activity score varied from 4.7 to 6.3 points. Degenerative osteoarthritis was frequently noted at the time of the most recent follow-up. There were few complications reported.

CONCLUSION

Arthroscopically assisted single-bundle transtibial posterior cruciate ligament reconstruction for isolated posterior cruciate ligament tears can improve posterior knee laxity by 1 grade, although this procedure does not reliably restore normal knee stability. Return to recreational and athletic activity was predictable, with 75% of patients exhibiting a normal or nearly normal objective outcome, although degenerative osteoarthritis was not prevented by this procedure.

Hydroxyapatite coating enhances polyethylene terephthalate artificial ligament graft osseointegration in the bone tunnel

The purpose of this study was to investigate whether hydroxyapatite (HAp) coating could induce polyethylene terephthalate (PET) artificial ligament graft osseointegration in the bone tunnel. Twenty-four New Zealand white rabbits underwent artificial ligament graft transplantation in bilateral proximal tibia tunnels. One limb was implanted with HAp-coated PET graft, and the contralateral limb was implanted with non-HAp-coated PET graft as control. The rabbits were randomly sacrificed at four and eight weeks after surgery. The loads to failure of the experimental group at eight weeks were significantly higher than those of the control group (p = 0.0057). Histologically, application of HAp coating induced new bone formation between graft and bone at eight weeks compared with the controls. Real-time polymerase chain reaction examination revealed significantly elevated messenger ribonucleic acid expression levels of osteopontin and collagen I in the grafts of the HAp group compared with the controls at four weeks (p < 0.05). The study has shown that HAp coating on the PET artificial ligament surface has a positive effect in the induction of artificial ligament osseointegration within the bone tunnel.

Evaluation of reconstructive surgery using artificial ligaments in 71 acute knee dislocations

This retrospective study assessed the results of 71 patients with knee dislocations who underwent acute combined repair and reconstruction using Ligament Advancement Reinforcement System (LARS) artificial ligaments between June 1996 and May 2008 with a follow-up between two and eight years. The outcome measures used were the Lysholm score, the International Knee Documentation Committee form (IKDC 2000), the Tegner activity level score, the Meyers ratings, Telos stress radiography, range of motion and clinical knee stability testing. When comparing high- versus low-energy dislocations and knee dislocation (KD) II/III versus KD IV injuries, a better Lysholm score for the knee dislocation (KD) II/III group was found compared with the KD IV group. The subjective and objective findings from our study are satisfactory and comparable with the results of other studies of knee dislocations. Our findings suggest that with a mean follow-up of 54 months, acute combined repair and reconstruction with LARS ligaments is a valid alternative for treating knee dislocations.

Clinical outcome after reconstruction for isolated posterior cruciate ligament injury

Fifty-one patients were operated with reconstruction for an isolated PCL injury from 1997 to 2005. Forty-three of these patients were followed during a median period of 48 months (17-109). Median time from injury to surgery was 18 months (2-368). Five patients were operated within the first 6 months after the injury. Nineteen patients had a BPTB autograft, 24 had a hamstring tendon autograft, and seven patients in the hamstring group had a double-bundle femoral fixation. Clinical assessment included Lysholm knee score, International Knee Documentation Committee 2000 (IKDC) scores, Cincinnati score, Tegner score, KOOS score, VAS score, stress radiographs, and a functional test. The median Lysholm score at follow-up was 80 (32-95). Median Tegner score before injury was 7 (1-10) and at follow-up 6 (0-9). Median Cincinnati and IKDC 2000 scores were 74 (12-100) and 63 (24-100), respectively. The mean VAS for subjective assessment of knee function was 67.6 (SD = 22.9). The radiologically measured difference in posterior tibial translation between operated and non-injured knees was mean 8.4 mm (SD =4.8). Four different functional tests showed function of the operated leg from 92% (25-128) to 95% (15-124) compared to the opposite leg. This study shows good functional outcome after reconstruction for isolated rupture of the posterior cruciate ligament. However, pain and instability are still a problem, as only three patients reported full Lysholm subscore indicating full stability, and only four patients reported full subscore indicating no knee pain.

Arthroscopic posterior cruciate ligament reconstruction using LARS artificial ligament: a retrospective study

BACKGROUND

The aims of this study were to analyze the preliminary clinical effects of arthroscopic reconstruction of posterior cruciate ligament (PCL) using Ligament Advanced Reinforcement System (LARS) artificial ligament. It is hypothesized that LARS artificial ligament is a safe and effective choice for PCL reconstruction, providing good knee stability.

MATERIALS AND METHODS

Forty-one patients who underwent PCL reconstruction using LARS artificial ligament were enrolled in this retrospective study. Average age at time of surgery was 34 y (range, 23-57 y). Average time from injury to surgery was 15 d (range, 5-45 d). Average follow-up period was 44 mo (range, 36-54 months). Follow-up examinations included the Lysholm Knee Score and the International Knee Documentation Committee (IKDC) score.

RESULTS

The average Lysholm knee score was 64.9 ± 8.8 preoperatively (range, 47-75) versus 92.1 ± 3.3 three years after operation (range, 79-100). Thirty-six of 41 patients (88%) showed good or excellent results at final assessment. The final IKDC score at 3 y postoperatively rated as normal in 21 patients (51%), nearly normal in 17 patients (42%), abnormal in three patients (7%).

CONCLUSIONS

The results shows that LARS artificial ligament appears to be an effective device for PCL reconstruction leading to good ligamentous stability and knee function. Long-term follow-up should be performed to confirm the durable stability of the knee and the tolerance of the knee to the LARS artificial ligament.