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LARS Ligament What’s the fuss all about?

LARS Ligament What’s the fuss all about?. Media Love LARS. “Miracle op to melt down surgeons' phones” “Is LARS revolution about to start?” . Players, Coaches and Clubs Love LARS. “Rodan's LARS recovery stuns coaches” “Rodan back two weeks after knee surgery”. Club Doctors Love LARS.

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LARS Ligament What’s the fuss all about?

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  1. LARS LigamentWhat’s the fuss all about?

  2. Media Love LARS “Miracle op to melt down surgeons' phones” “Is LARS revolution about to start?”

  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?

  7. LIGAMENT ADVANCEDREINFORCEMENT SYSTEM (LARS) ARTIFICIAL LIGAMENT • Polyethylene Terephthalate (PET). • PET - Encourage ingrowth • Intra-articular segment • Twist

  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 >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

  10. LARS Literature • 12 papers found reporting on the LARS • 6 publications in Chinese literature. • 4 compared to autograft (1 PT 3 HT)

  11. 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)

  12. 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 – 98.7 • 1 case synovitis reported

  13. 4 Comparison Papers • No difference in the 10 outcome measures at final follow up (15 – 49 months). • LARS patients reached full recovery sooner.

  14. 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.

  15. Is there an optimal time to insert? • acute injuries • good ACL stump • well vascularised

  16. 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.

  17. Long Term Results LARS Other PET grafts • Stryker Graft • Proflex • Lygeon • Leeds-Keio • ABC Surgicraft • Ligastic

  18. Poor Results • High failure rates • Poor Outcome Scores (Lachman, Pivot, IKDC) • Concerns regarding development of OA

  19. Pittsburgh Group

  20. Electron Microscopy

  21. 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

  22. Recommendations • Reporting and follow up is important. • Randomised trials. • Patients - informed of our knowledge of LARS. • Need for ACL register?

  23. Thankyou

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