Presentation on theme: "LARS Ligament What’s the fuss all about?. Media Love LARS “Miracle op to melt down surgeons' phones” “Is LARS revolution about to start?”"— Presentation transcript:
LARS Ligament What’s the fuss all about?
Media Love LARS “Miracle op to melt down surgeons' phones” “Is LARS revolution about to start?”
“Rodan's LARS recovery stuns coaches” “Rodan back two weeks after knee surgery” Players, Coaches and Clubs Love LARS
Club Doctors Love LARS "It's a ridiculous recovery,“ "This will become the norm"
High Level of Patients Awareness Asking for them or about them.
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?
LIGAMENT ADVANCED REINFORCEMENT SYSTEM (LARS) ARTIFICIAL LIGAMENT Polyethylene Terephthalate (PET). PET - Encourage ingrowth Intra-articular segment – Twist
Methods A systemic review process was undertaken Any article reporting on outcomes of the LARS ligament
10 Specific Outcomes Measures Loss of Range of motion (flexion or extension loss > 5 degree) Lachman Grade >II Pivot shift grade >II IKDC score (% of patients scored A or B) Lysholm score and Tegner Score KT-1000 Muscle strength (flexion and extension strength), Surgery Complications – Specifically graft rupture or revision, – synovitis – osteoarthritis
LARS Literature 12 papers found reporting on the LARS 6 publications in Chinese literature. 4 compared to autograft (1 PT 3 HT)
12 LARS Papers Total 655 LARS grafts. Methodology – retrospective case series. Av. Age patients 21 – 46 Av. Time to surgery 7 months Av. Follow up 28 months (4-60 months)
Reported Outcomes Lachman grade – 12% Grade II or more (60 of 499 grafts, 7 articles) Pivot shift – 5% grade II or more (20 of 515 grafts, 7 articles) 14 reported ruptures (2%) Lysholm Post op value of 82.8 – case synovitis reported
ArticleYear Journal NumberAv Age Time to surgery Av F/U Months 1Derricks1995 Operative techniques Sports Medicine Lavoie2000Knee Duval **2002JBJS Qi S2005Chin J Min Inv Surg Chen S **2007Chin J Sports Med Dong2007Chin J Orthop Trauma Cerelli2007SIOT Fan**2008 Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi Liu **2009International Orthopaedics Chen M2009 Chin J Reparative and Recon Surgery Gao2010Arthroscopy Huang2010Chin Medical Journal
4 Comparison Papers No difference in the 10 outcome measures at final follow up (15 – 49 months). LARS patients reached full recovery sooner.
Correspondence Dr Nicolas Duval Best results are in early ACL repair augmented by LARS – Expect 80 to 90% good results at 10 years. Chronic ACL tear - 50% failure at 10 years Revision ACL surgery - 40% failure at 10 years.
Is there an optimal time to insert? acute injuries good ACL stump well vascularised
Tissue Ingrowth 2 Papers Yu – (Chinese) Rabbits – If the stump was left - Connective tissue covering – at 6 months irregular collagen bundles with no mature ligamentisation. Trieb – Invitro cellular ingrowth into LARS – Invivo – Ingrowth in a quads tendon.
Long Term Results LARS Other PET grafts – Stryker Graft – Proflex – Lygeon – Leeds-Keio – ABC Surgicraft – Ligastic
Poor Results High failure rates Poor Outcome Scores (Lachman, Pivot, IKDC) Concerns regarding development of OA
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
Recommendations Reporting and follow up is important. Randomised trials. Patients - informed of our knowledge of LARS. Need for ACL register?