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

Knee Surg Sports Traumatol Arthrosc. 2019 Nov;27(11):3626-3632. doi: 10.1007/s00167-019-05478-3. Epub 2019 Mar 22.

Abstract

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.

Keywords: ACL; ACL reconstruction; Anterior cruciate ligament; Knee; Knee ligament; Knee surgery; LARS; Ligament Augmentation and Reconstruction System; Reconstruction; Sports knee; Synthetic graft; Synthetic ligament.

MeSH terms

  • Adult
  • Anterior Cruciate Ligament Injuries / physiopathology
  • Anterior Cruciate Ligament Injuries / surgery*
  • Anterior Cruciate Ligament Reconstruction / adverse effects
  • Anterior Cruciate Ligament Reconstruction / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Joint Instability / surgery
  • Ligaments, Articular / surgery*
  • Male
  • Middle Aged
  • Patient Reported Outcome Measures
  • Polyethylene Terephthalates
  • Postoperative Complications / surgery
  • Prostheses and Implants*
  • Range of Motion, Articular
  • Reoperation
  • Rupture / surgery
  • Treatment Outcome
  • Young Adult

Substances

  • Polyethylene Terephthalates