scholarly journals A case report of traumatic osteoarthritis associated with LARS artificial ligament use in anterior cruciate ligament reconstruction

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuanliang Du ◽  
Haifeng Dai ◽  
Zhihui Wang ◽  
Di Wu ◽  
Changjiang Shi ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Giant Cells ◽  
X Rays ◽  
Artificial Ligament ◽  
Late Failure ◽  
Anterior Cruciate ◽  
Lars Artificial Ligament

Abstract Background A ligament advanced reinforcement system (LARS) artificial ligament has been proposed for use in anterior cruciate ligament (ACL) reconstruction, and many reports have shown its success in ACL reconstruction. However, there are great concerns about the potential risk of complications, which might prevent its extensive use. Late failure may occur due to serious complications. Case presentation We report a rare case of serious osteoarthritis that occurred 2 years postoperatively in a 51-year-old man who underwent reconstruction with an LARS artificial ligament. In X-rays, the tibial tunnel was placed too posteriorly. MRI showed that the tibial tunnel was enlarged, and there was a large effusion in the knee joint. The LARS device was rough and worn. Histologically, a large number of fibroblasts and a few multinucleated giant cells infiltrated the graft fibres. Conclusion Our findings remind surgeons that an LARS device should be with great caution in ACL reconstruction.

The Effect of Remnant Preservation on Tibial Tunnel Enlargement in Anterior Cruciate Ligament Reconstruction with Polyethylene Terephthalate Artificial Ligament in a Large Animal Model

2018 ◽  
Vol 32 (11) ◽  
pp. 1094-1101
Author(s):  
Jiangyu Cai ◽  
Fang Wan ◽  
Chengchong Ai ◽  
Wenhe Jin ◽  
Dandan Sheng ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Bone Tunnel ◽  
Control Group ◽  
Micro Ct ◽  
Tunnel Enlargement ◽  
Artificial Ligament ◽  
Remnant Preservation ◽  
Anterior Cruciate

AbstractAn enlarged bone tunnel may affect the graft–bone integration and pose a problem for revision anterior cruciate ligament (ACL) surgery. The purpose of this study was to evaluate the effect of remnant preservation on tibial tunnel enlargement in ACL reconstruction with polyethylene terephthalate (PET) artificial ligament. Twenty-four skeletally mature male beagles underwent ACL reconstruction with PET artificial ligament for both knees. One knee was reconstructed with remnant preservation using sleeve technique (remnant group), while the contralateral was reconstructed without remnant preservation (control group). The animals were sacrificed at 1 day, 6 weeks, and 12 weeks after surgery for further evaluation including macroscopic observation, microcomputed tomography (micro-CT), histological assessment, and biomechanical testing. The remnant group had better synovial coverage than the control group at 6 and 12 weeks after surgery. The micro-CT analysis showed the tibial tunnel area (TTA) of the remnant group was significantly smaller and the bone volume/total volume fraction (BV/TV) value was higher than those of the control group at 6 and 12 weeks. Moreover, TTA and BV/TV at each time point were divided into three groups according to the different grade of synovial coverage. Significant association was observed between the synovial coverage degree and the TTA and BV/TV values. The histological assessment revealed that the interface width between the graft and host bone in the remnant group was smaller than that in the control group in the tibial tunnels at 6 and 12 weeks. Moreover, the remnant group had better failure load and stiffness than the control group at 12 weeks. The remnant preservation using sleeve technique could effectively promote the synovial coverage of the graft, decrease the risk of tibial tunnel enlargement by sealing the bone tunnel entrance, and enhance the biological environment for graft–bone healing after ACL reconstruction using PET artificial ligament. This technique provides a potential solution for bone tunnel enlargement following artificial ligament surgery for the acute ACL rupture in the clinical practice.

scholarly journals Preliminary Results in Anatomic All-inside Anterior Cruciate Ligament Reconstruction

2016 ◽  
Vol 1 (s2) ◽  
pp. 23-26
Author(s):  
Octav Russu ◽  
Tiberiu Bățagă ◽  
Andrei-Marian Feier ◽  
Radu Prejbeanu ◽  
Radu Fleaca ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Clinical Results ◽  
Lysholm Score ◽  
X Rays ◽  
The Mean ◽  
Anterior Cruciate

Abstract Introduction: Anterior cruciate ligament (ACL) rupture is one of the most common lesions in knee traumatology; therefore the number of ACL reconstructions is increasing worldwide. Usually, an anteromedial (AM) accessory portal is required in anatomical positioning of the femoral tunnel, which is not absolutely necessary in this technique. Aim: Assessment of all-inside ACL reconstruction preliminary clinical results with adjustable loops and buttons on both femoral and tibial surfaces. Method: Our prospective study included 28 subjects (19 male, 9 female) with chronic ACL ruptures. The mean age of the study population was 27.72 ± 8.23 years. In all cases ACL reconstruction was carried out with the use of quadrupled semitendinosus auto-grafts with adjustable loops and buttons on the femoral and tibial surfaces and anatomic placement of both tunnels, using an outside-in technique, with flipcutters (Arthrex®). Clinical and radiological evaluations were carried out before surgery and at 3 and 6 months postoperatively, with the Lysholm scoring system, the Tegner activity scale and anterior-posterior and latero-lateral X-rays. Anterior knee laxity was measured in 25° of flexion using a portable arthrometer (RolimeterTM, Aircast®) and maximum manual force. Results: During the final follow-up, the Lysholm score was good and excellent in 27 cases, with a mean Lysholm score of 95.55 ± 4.63; all results were classified as good. The mean preoperative Tegner activity score was 3.46 ± 1.71 (range: 1-7), and the post-operative mean score was 5.75 ± 2.24 (range: 2-10). We found no graft ruptures. Preoperative knee laxity measurements showed a mean displacement of 11.5 ± 3.1 mm and side-to-side differences of 5.6 ± 3.5 mm, while the postoperative measurements at the last follow-up were 6.3 ± 1.54 mm and 2.65 ± 1.86 mm, respectively. Conclusion: Short-term clinical outcomes of all-inside ACL restoration with anatomic placement femoral and tibial tunnels seem to recommend this surgical option, with good subjective and objective results. Additional research will have to prove the long-term success.

scholarly journals Evaluation of a novel lower radiation computed tomography protocol for assessment of tunnel position post anterior cruciate ligament reconstruction

2020 ◽  
Author(s):  
varun vasudeva ◽  
Stephen Key ◽  
Alfred Phillips ◽  
Steve Kahane ◽  
Joseph Stevens ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Anterior Cruciate Ligament ◽  
Radiation Dose ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Effective Radiation Dose ◽  
Tunnel Position ◽  
Anterior Cruciate ◽  
Conventional Ct

Abstract Background Anterior cruciate ligament (ACL) reconstruction is a common orthopaedic procedure. We developed a novel, low dose computed tomography (LDCT) protocol to assess tunnel position post-operatively. The effective radiation dose of this protocol is <0.5mSv, which is significantly less than the 2mSv dose for a conventional CT protocol. The aim of this study was to assess the accuracy of the LDCT protocol for determining tunnel position. Methods Twenty-six patients who underwent primary ACL reconstruction were included in the study. A LDCT scan was performed six weeks post-operatively. Femoral and tibial tunnel positions were measured on three dimensional (3D) reconstructions using previously validated techniques. Measurements were performed independently by three observers at two time points, four weeks apart. Results There was excellent intra- and inter-rater reliability for all measurements using the images obtained from the LDCT protocol. Intra-class correlation coefficient (ICC) values were >0.9 for all measurements. Conclusions The LDCT protocol described in this study accurately demonstrates femoral and tibial tunnels post ACL reconstruction, while exposing the patient to a quarter of the radiation dose of a conventional CT. This protocol could be used by orthopaedic surgeons for routine post-operative imaging, in place of plain film radiographs.

Comparison of Acorn and Fluted Reamers on Tibial Tunnel Outer Aperture Dimensions in Anterior Cruciate Ligament Reconstruction

2020 ◽  
Author(s):  
Adam D. Gerrard ◽  
Chris M. Jump ◽  
Paul Sutton ◽  
Charalambos P. Charalambous
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Aperture Width ◽  
The Mean ◽  
Anterior Cruciate ◽  
Degree Deviation ◽  
Substantial Change

AbstractThe aim of this study was to determine if the type of reamer used in tibial tunnel creation during anterior cruciate ligament (ACL) reconstruction influences the dimensions of the tunnel's outer aperture. Tibial tunnels were created in tibial saw bones by reaming over a guidewire using an 8 mm acorn or fluted reamer in an antegrade manner. Reaming was aimed either in line with the guidewire, or with 10-degree inferior/superior deviation in relation to the wire. The shape and size of the outer aperture of the tibial tunnel were compared between the two reamers. When using the acorn reamer, a 10-degree deviation in relation to the guidewire resulted in minimal change in outer aperture length (mean 13.6 vs. 15.6 mm, p = 0.11) and width (11.6 vs. 11.1 mm, p = 0.51). However, when using the fluted reamer, although the aperture width showed no substantial change with reamer/guidewire deviation (11.4 vs. 11.2 mm, p = 0.71), the mean length almost doubled (14.7 vs. 28.1 mm, p = 0.002). The use of a fluted reamer when reaming the tibial tunnel creates a distal aperture which is inconsistently sized, larger, and of oblong shape compared with an acorn-shaped reamer. This should be taken in consideration when using a fluted reamer for creating the tibial tunnel in ACL reconstruction.

ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH LARS ARTIFICIAL LIGAMENT: AN 8–15-YEAR FOLLOW-UP

2013 ◽  
Vol 13 (02) ◽  
pp. 1350046 ◽  
Author(s):  
CHO-LIN WANG ◽  
CHIH-KUN HSIAO ◽  
MING-CHOU KU ◽  
CHIH-HAN CHANG
Keyword(s):  
Anterior Cruciate Ligament ◽  
Survival Rate ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Clinical Results ◽  
Lysholm Score ◽  
Artificial Ligament ◽  
Anterior Cruciate ◽  
Lars Artificial Ligament

The aim of this study was to evaluate the clinical results of anterior cruciate ligament (ACL) reconstruction with an artificial ligament of the Ligament Augmentation and Reconstruction System (LARS) via an 8–15-year follow-up. Between January 1996 and January 2003, 38 patients received arthroscopic anterior cruciate reconstruction with the LARS artificial ligament at the Show Chwan Memorial Hospital, Changhua, Taiwan. Among them, 28 cases were included in this study. Excluding two failure cases, 26 cases were involved in the statistical analysis of various clinical assessments. The mean follow-up period after reconstruction was 11.4 ± 1.9 years. Assessment of clinical results included physical examination, magnetic resonance imaging, radiography, KT-1000 arthrometer test for knee stability, range of motion measurement, Lysholm score, and Tegner scale activity evaluations. The outcomes showed that among these 28 follow-up patients, there were two failure cases. The survival rate of LARS ligament reconstruction in this long-term follow-up was 92.9%. Among the 26 clinical assessed cases, the stability of the knee joint was improved as the anterior translation displacement measured by arthrometer reduced from 7.0 ± 3.1 mm (range: 4–17 mm) pre-operatively to 1.7 ± 1.7 mm (range: 0–6 mm) post-operatively. The Lysholm score improved from 39.7 ± 11.5 pre-operatively to 85.9 ± 19.6 post-operatively. Tegner activity scale improved from 3.2 ± 1.5 pre-operatively to 5.4 ± 2.4 post-operatively. All three improvements have statistic significance as the p-values were less than 0.05. In conclusion, ruptured ACL reconstruction with LARS artificial ligament has a survival rate of 92.9% and complication rate of 28.6% in this 8–15-year follow-up.

Evaluating the Accuracy of Tibial Tunnel Placement After Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 47 (13) ◽  
pp. 3187-3194 ◽  
Author(s):  
Christopher Pedneault ◽  
Carl Laverdière ◽  
Adam Hart ◽  
Mathieu Boily ◽  
Mark Burman ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
3D Mri ◽  
Tunnel Placement ◽  
Anatomic Acl Reconstruction ◽  
Imaging Protocol ◽  
Tibial Footprint ◽  
Anterior Cruciate

Background: Anatomic anterior cruciate ligament (ACL) reconstruction improves knee kinematics and joint stability in symptomatic patients who have ACL deficiency. Despite a concerted effort to place the graft within the ACL’s native attachment sites, the accuracy of tunnel placement using contemporary techniques is not well established. Purpose: To use 3-dimensional magnetic resonance imaging (3D MRI) to prospectively evaluate the accuracy of tibial tunnel placement after anatomic ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: Forty patients with symptomatic, ACL-deficient knees were prospectively enrolled in the study and underwent 3D MRI of both their injured and uninjured knees before and after surgery through use of a validated imaging protocol. The root ligament of the anterior horn of the lateral meniscus was used as a radiographic reference, and the center of the reconstructed graft was compared with that of the contralateral normal knee. The tunnel angles and intra-articular graft angles were also measured, as was the percentage overlap between the native tibial footprint and tibial tunnel. Results: The reconstructed tibial footprint was placed at a mean ± SD of 2.14 ± 2.45 mm ( P < .001) medial and 5.11 ± 3.57 mm ( P < .001) posterior to the native ACL footprint. The mean distance between the center of the native and reconstructed ACL at the tibial attachment site was 6.24 mm. Of the 40 patients, 18 patients had a tibial tunnel that overlapped more than 50% of the native footprint, and 10 patients had maximal (100%) overlap. Further, 22 of the 40 patients had less than 50% overlap with the native footprint, and in 12 patients the footprint was missing completely. Conclusion: Despite the use of contemporary surgical techniques to perform anatomic ACL reconstruction, a significant positioning error in tibial tunnel placement remains.

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