Presentation
Recent LARS reconstruction of ACL. Now knee pain, ? meniscal tear
Patient Data
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 utilizes synthetic fibers (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 fibers and synovial lining that normally envelops the ligament, in order to visualize 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 fibers 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 maximize 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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