2 Media Love LARS “Miracle op to melt down surgeons' phones” “Is LARS revolution about to start?”2
3 Players, Coaches and Clubs Love LARS “Rodan's LARS recovery stuns coaches”“Rodan back two weeks after knee surgery”
4 Club Doctors Love LARS "It's a ridiculous recovery,“ "This will become the norm"
5 High Level of Patients Awareness Asking for them or about them.
6 Lots of Hype – Evidence based answers Should we be incorporating this graft into our practice?Better than autograft?Durability?Do they cause OA?Can they be revised?Which patients should it be used on?Any Specific Advantages?Optimal time to insert?
8 Methods A systemic review process was undertaken Any article reporting on outcomes of the LARS ligament
9 10 Specific Outcomes Measures Loss of Range of motion (flexion or extension loss > 5 degree)Lachman Grade >IIPivot shift grade >IIIKDC score (% of patients scored A or B)Lysholm score and Tegner ScoreKT-1000Muscle strength (flexion and extension strength),Surgery ComplicationsSpecifically graft rupture or revision,synovitisosteoarthritis
10 LARS Literature 12 papers found reporting on the LARS 6 publications in Chinese literature.4 compared to autograft (1 PT 3 HT)10
11 12 LARS Papers Total 655 LARS grafts. Methodology – retrospective case series.Av. Age patients 21 – 46Av. Time to surgery 7 monthsAv. Follow up 28 months (4-60 months)
12 Reported Outcomes Lachman grade Pivot shift 14 reported ruptures (2%) 12% Grade II or more (60 of 499 grafts, 7 articles)Pivot shift5% grade II or more (20 of 515 grafts, 7 articles)14 reported ruptures (2%)Lysholm Post op value of 82.8 – 98.71 case synovitis reported
13 655 21-46 6.7 27.8 Article Year Journal Number Av Age Time to surgery ArticleYearJournalNumberAv AgeTime tosurgeryAv F/UMonths1Derricks1995Operative techniques Sports Medicine22033.4302Lavoie2000Knee4731.6223Duval **2002JBJS26315244Qi S2005Chin J Min Inv Surg1633.719Chen S **2007Chin J Sports Med2328.2156DongChin J Orthop Trauma2135.71.597CerelliSIOT254610608Fan**2008Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi18Liu **2009International Orthopaedics283649Chen MChin J Reparative and Recon Surgery323.211Gao2010Arthroscopy1595012HuangChin Medical Journal4329655 21-466.727.8
14 4 Comparison PapersNo difference in the 10 outcome measures at final follow up (15 – 49 months).LARS patients reached full recovery sooner.
15 Correspondence Dr Nicolas Duval Best results are in early ACL repair augmented by LARSExpect 80 to 90% good results at 10 years.Chronic ACL tear - 50% failure at 10 yearsRevision ACL surgery - 40% failure at 10 years.15
16 Is there an optimal time to insert? acute injuriesgood ACL stumpwell vascularised
17 Tissue Ingrowth 2 Papers Yu – (Chinese) Rabbits Trieb If the stump was left - Connective tissue coveringat 6 months irregular collagen bundles with no mature ligamentisation.TriebInvitro cellular ingrowth into LARSInvivo – Ingrowth in a quads tendon.
18 Long Term Results LARS Other PET grafts Stryker Graft Proflex Lygeon Leeds-KeioABC SurgicraftLigastic
19 Poor Results High failure rates Poor Outcome Scores (Lachman, Pivot, IKDC)Concerns regarding development of OA
22 Conclusion There is sparse and poor quality literature Early results of LARS good.Faster recovery but NOT BETTER than autograft.Concern based on previous PET grafts possibility late failure and iatrogenic OA
23 Recommendations Reporting and follow up is important. Randomised trials.Patients - informed of our knowledge of LARS.Need for ACL register?