Sports Knee Surgery ACL Graft Choice . Dr Jonathan Mulford myorthopod.com.au. Who am I?. ACL Surgery. What do you think of the LARS?. What Are you asking me?. What is the best graft? What would you have?. Graft Choice. Autograft – Patients own tissue Allograft – someone else's tissue
Dr Jonathan Mulford
What do you think of the LARS?
What is the best graft? What would you have?
Autograft – Patients own tissue
Allograft – someone else's tissue
Synthetic - Artificial
Leo P – Hamstrings
Merv C – Patella tendon
Koreans Quads Tendon
Footy show says Synthetic Graft
LARS option: Fisher aims for fast return
David Rodan back on training track two weeks after knee surgery
Miracle op to melt down surgeons' phones
Rodan surgery to become the norm
Covell's career on knife's edge
Moltzen plays it safe
Allograft significantly lower normal stability rates than autograft
Allograft abnormal stability rate 3 times greater than autograft.
What does the literature tell us.
Remember there is a lot of poor literature.
Currently performing Systematic review.
No difference to BTB
Quads strength? /
less anterior knee pain ? /
Choose graft that matches the patients needs.
Discuss the pros and cons of each graft.
Have been used for over 30years
Avoids the donor site morbidity, quicker recovery, cheat biology.
Problem has been their durability – they have not matched autograft in this regard.
Lion opts for LARS 11/5/2010
1918 silk sutures – failed 3 months
First graft 1973 - Proplast made of polytetrafluoroethylene (PTFE)
Results with this system yielded an average time to breakage of just over 1 year.
Began late 70s
carbon wear particles
coated with collagen and absorbable polymers
Good Early results
longer term - unacceptable stretching and complete rupture as major complications.
tightly woven polyester strips.
Early results were good
however by 4 years about 50% had failed due to stretching of the graft.
a polyester mesh
intended as a scaffold for soft tissue ingrowth
Good early results.
a large number of long-term graft ruptures despite excellent early results
Ligament Augmentation Device (LAD) in 1980.
Idea - protect the autogenous tissue graft early
Problem - Stress shielding resulted.
Later - effusion and synovitis.
One case synovitis reported short term.
Short term results in a handful of papers are good.
Fast recovery and return to sport/activity.
risk of rupture remain and must be addressed through long-term follow-up studies.
ACL Reconstruction Using Artificial Ligament: Five Years Follow Up
S.I.O.T. 2007; 33(suppl.1) : 8238-8242G. Cerulli et at. 25 patients older than 40 - Lars® artificial ligaments at a five-years follow-up with very good results.
Best results are in early ACL repair augmented by LARS
In older patients (more than 50) I use the LARS in any condition because of the low morbidity and easy rehab.
No Donor site Morbidity
Graft not going to weaken early.
Sportsmen who have acute injury require fast recovery for particular target time AND prepared to take the risks possible long term failure.
Older patients with less demands however functional instability and want less involved rehab.