LARS anterior cruciate ligament reconstruction

Case contributed by Dr Chris O'Donnell

Presentation

Recent LARS reconstruction of ACL. Now knee pain, ? meniscal tear

Patient Data

Age: 35
Gender: Male
Modality: MRI

ACL graft has a "braided" appearance (LARS) on MRI compared with the normal tendon-like appearance of grafts from the traditional patellar or semitendinosis donor sites

Case Discussion

LARS = Ligament Augmentation and Reconstruction System is an internal fixation device providing a scaffold for natural tissue in-growth.  It utilises synthetic fibres (terephthalic polyethylene polyester) in a ‘pre-twisted parallel’ pattern that is supposed to mimic normal ligaments providing strength with resistance to elongation. It is non-absorbable and is said to provide a meshwork for the injured ligament to heal and repair.

Traditional ACL reconstruction techniques require debriding of the torn ACL fibres and synovial lining that normally envelops the ligament, in order to visualise the position for the graft.  The LARS surgical technique uses intra operative image intensifier to position the tunnels through the ACL stump and is therefore able to leave the synovial lining and the torn ACL fibres insitu. The proposed advantage of this technique is reduced trauma to the soft tissues of the knee and less surgical time.  The ACL stump is then anchored to the meshwork of the LARS to support it in an optimum position while healing. Thus the LARS surgical technique aims to maximise in-growth of the original ACL tissue preserving some vascular and proprioceptive nerve supply.

As a result of the reduced trauma required during surgery, return time to active sport is reduced substantially although long term results are not yet clear.

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Case Information

rID: 33314
Case created: 7th Jan 2015
Last edited: 21st Nov 2015
Inclusion in quiz mode: Included

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