Reconstruction of the anterior cruciate ligament using the polyester ABC ligament scaffold

The Effectiveness of Autograft Used in Anterior Cruciate Ligament Reconstruction of the Knee: Surgical Records for the New Generations of Orthopedic Surgeons and Synthetic Graft Revisit

Objective

In this article, we aim to revisit the synthetic graft and review the advantages and disadvantages between different types of grafts for patients who underwent anterior cruciate ligament (ACL) reconstruction in a tertiary medical institute for the new generations of surgeons.

Patients and Methods

Retrospectively, we identified 115 patients who underwent arthroscopic ACL reconstruction between 2006 and 2009. We were able to retrieve 74 patients from them. The 74 patients were divided into 32 patients who underwent primary arthroscopic ACL reconstruction with hamstring and patellar tendon autograft and 42 cases with an active biosynthetic composite (ABC) ligament. The mean the follow-up period for both groups was 7 years. The following information was obtained: standard demographic information (age, sex), clinical presentation, presence of trauma, associated injuries, types of grafts (autograft versus synthetic graft) and postoperative complications. Moreover, functional and clinical outcomes in addition to the satisfaction of patients using the international knee documentation committee (IKDC) score and knee injury and osteoarthritis outcome score (KOOS) were measured.

Results

We found that the natural (autograft) was better in terms of clinical and functional outcome than the synthetic one (the scores of KOOS and IKDC were better in natural grafts). Furthermore, the immediate postoperative results for the pivot and Lachman tests were better in natural grafts. On the other hand, the rate of re-rupture was similar for both groups. However, the long-term inflammatory changes and stiffness that is attributed to the immunological reactions were more in the synthetic grafts.

Conclusion

This study revisited the synthetic graft and provided evidence that the natural grafts are more beneficial with less complications, as they had better immediate and long-term postoperative clinical and functional outcomes. We recommend the utilization of autograft as first choice and the synthetic not to be used given the current criteria.

LARS Artificial Ligament Versus ABC Purely Polyester Ligament for Anterior Cruciate Ligament Reconstruction

Background:

Graft choice for anterior cruciate ligament (ACL) reconstruction is of critical importance. Various grafts have been used so far, with autografts long considered the optimal solution for the treatment of ACL-deficient knees. Limited data are available on the long-term survivorship of synthetic grafts.

Purpose:

To compare the functional outcome and survivorship of ACL reconstructions performed using the LARS (ligament augmentation and reconstruction system) ligament and the ABC (active biosynthetic composite) purely polyester ligament.

Study Design:

Case series; Level of evidence, 4.

Methods:

The results of 72 patients who underwent primary arthroscopic ACL reconstruction with the LARS ligament and 31 cases with an ABC purely polyester ligament were reviewed. The mean follow-up periods for the LARS and ABC groups were 9.5 and 5.1 years, respectively. A survivorship analysis of the 2 synthetic grafts was performed using the Kaplan-Meier method with a log-rank test (Mantel-Cox, 95% CI). Lysholm, Tegner activity, Knee injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) scores as well as laxity measurements obtained using a KT-1000 arthrometer were recorded for all intact grafts, and a Mann-Whitney U test was used for comparison reasons.

Results:

The rupture rates for LARS and ABC grafts were 31% (95% CI, 20%-42%) and 42% (95% CI, 25%-59%), respectively. For intact grafts, the mean Lysholm score was good for both groups (90 for the LARS group and 89 for the ABC group), with the majority of patients returning to their preinjury level of activities, and the mean IKDC score was 90 for the LARS group and 86 for the ABC group.

Conclusion:

The rupture rates of both LARS and ABC grafts were both high. However, the LARS ligament provided significantly better survivorship compared with the ABC ligament at short- to midterm follow-up (95% CI).

Anterior cruciate ligament reconstruction: a systematic review of polyethylene terephthalate grafts

BACKGROUND

The ligament advanced reinforcement system (LARS) ligament is an artificial polyester ligament made from polyethylene terephthalate (PET) that is used for primary anterior cruciate ligament (ACL) reconstructive surgery. Recent media attention has resulted in a high awareness of this reconstructive option among patients; however, the outcomes compared with autograft are controversial.

OBJECTIVES

A systematic review of the literature was undertaken to examine the outcomes following LARS and long-term PET artificial grafts in ACL reconstructive surgery. The ultimate objective was to determine whether the LARS ligament should be incorporated into routine practice.

METHODS

A systematic search strategy from 1970 to June 2010 was used to retrieve relevant studies. Inclusion of articles was established through application of a predetermined protocol, independent assessment by two reviewers and a final consensus decision.

RESULTS

Twelve articles met the inclusion criteria for the LARS ligament. The methodology of the identified articles was poor. Only short-term outcomes were available. These results were good with low complication rates. Eleven articles reported on other PET grafts and recorded long-term follow-up of more than 4 years. These grafts had poor outcomes and a high rate of complications. No meta-analysis was possible.

CONCLUSIONS

There are surprisingly few studies reporting on LARS ligament outcomes. The literature has poor methodological quality. Short-term results for the LARS ligament appear good, with faster recovery times compared with autografts. Final short-term results are not significantly different from autograft. There is real concern that late failure and iatrogenic osteoarthritis may occur based on the results of other PET grafts.