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

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 27; no. 11; pp. 3626 - 3632
• Main Authors: Tulloch, Scott John, Devitt, Brian Meldan, Porter, Tabitha, Hartwig, Taylor, Klemm, Haydn, Hookway, Sam, Norsworthy, Cameron John
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2019; Springer Nature B.V
• Subjects: Adult; Anterior cruciate ligament; Anterior Cruciate Ligament Injuries - physiopathology; Anterior Cruciate Ligament Injuries - surgery; Anterior Cruciate Ligament Reconstruction - adverse effects; Anterior Cruciate Ligament Reconstruction - methods; Complications; Failure; Failure rates; Female; Follow-Up Studies; Grafting; Grafts; Humans; Joint Instability - surgery; Knee; Ligaments; Ligaments, Articular - surgery; Male; Mechanical failure; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Patient Reported Outcome Measures; Patients; Polyethylene; Polyethylene terephthalate; Polyethylene Terephthalates; Postoperative Complications - surgery; Prostheses and Implants; Range of Motion, Articular; Reoperation; Rupture - surgery; Statistical analysis; Surgery; Survival; Treatment Outcome; Young Adult; Knee; Reconstruction; Synthetic graft; Knee surgery; ACL reconstruction; LARS; Knee ligament; Synthetic ligament; ACL; Sports knee; Anterior cruciate ligament; Ligament Augmentation and Reconstruction System
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-019-05478-3

Purpose The 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. Methods Results 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. Results The 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. Conclusion The 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 evidence III, cohort study.