2015 ISAKOS Biennial Congress ePoster #1116

Multi-Ligament Reconstruction of the Knee Using the LARS Ligament at a Mean of 5 Year Follow Up – A Prospective Case Series of 31 Patients

Pierre Hm Pechon, MB.ChB, B.Eng, M.Eng, London UNITED KINGDOM
Sally Wright, MB.CHB, London UNITED KINGDOM
Bobby Anand, FRCS(Tr&Orth), London UNITED KINGDOM
David Houlihan-Burne, FRCS, London UNITED KINGDOM
HILLINGDON AND MOUNT VERNON HOSPITALS, LONDON, LONDON, LONDON, UNITED KINGDOM

FDA Status Cleared

Summary: Reconstruction of Multi-ligament injuries of the knee using a LARS(Ligament Augmentation and Reconstruction System) ligament for the posterior cruciate ligament or postero-lateral corner is safe, effective and provides significant improvements in clinical and functional outcomes after a mean follow-up time of 5 years, with no failures of the graft or significant complications.

Abstract:

Background

the use of artificial ligaments in knee reconstruction remains controversial however there are many theoretical advantages, such as no donor-site morbidity and more consistent mechanical properties. Other studies have shown good short-term results however this is the largest case series of mid to long-term functional results.

Aim

The aim was to evaluate clinical and functional outcomes of posterior cruciate ligament (PCL) and postero-lateral corner (PLC) in the setting of a multi-ligament reconstruction in the knee using the LARS (Ligament Augmentation and Reconstruction System) artificial ligament.
STUDY DESIGN: prospective case series.

Methods

31 patients (23 male, 8 female) with multi-ligament knee injuries or isolated PCL injuries were treated with a minimum follow up of 53 months (range: 53-94 months, mean 68 months). Outcomes were assessed at 12 months, 24 months, and again at between 24 and 94 months (during September 2014) using the modified International Knee Documentation Committee score (IKDC), Tegner Activity Score and Lysholm score.

Results

There was significant improvement in subjective stability, function and patient satisfaction post-operatively (p=0.01). Most patients achieved a full functional range of movement within six months. No patients were lost to follow up. There were 2 complications, one superficial wound infection and one stiff knee that required manipulation under anaesthesia. We had no LARS ligament failures (RE-RUPTURES) in this group. When considered as a whole cohort of patients with either PCL or PLC reconstruction, the mean Lysholm score improved from 37 to 83, and mean IKDC score improved from 33 to 74. When sub-divided it appears that the PCL-only reconstruction cohort (n=7) had a slightly smaller increase in IKDC and Lysholm scores than the multi-ligament (rupture of 2 or more of the following: ACL, MCL, LCL, PCL, PLC) reconstruction cohort.

Discussion

In the medium and long term the LARS ligament appears to function well, with high patient satisfaction, no signs of progressive clinical laxity, synovitis, tunnel widening or re-ruptures. Our results are promising with no signs of problems typically associated with synthetic grafts used in the past. The LARS ligament appears to be an attractive alternative to the use of autografts and allografts for PCL, multi-ligament and PLC reconstruction.
CLINICAL RELEVANCE: To our knowledge this is the first and largest prospective case series reporting on the use of LARS for PCL, multi-ligament and PLC reconstruction. This data will be of value to sports knee surgeons involved in the treatment of multi-knee ligament injuries.