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

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.

Evaluation of Modified CC Stabilization Using LARS Artificial Ligament in Unstable Distal Clavicle Fracture

Background: Unstable distal clavicle fracture is common, and there is no consensus regarding the gold standard treatment. The purpose of this study was to report a new surgical technique for the treatment of unstable distal clavicle fracture with modified coracoclavicular (CC) stabilization using a ligament augmentation and reconstruction system (LARS) artificial ligament, and to evaluate the clinical and radiographic outcomes.Patients and methods: We retrospectively reviewed 18 patients with acute unstable distal clavicle fractures (type Ⅱb) treated between January 2009 and June 2018 with modified CC stabilization using LARS artificial ligament. Indexes for evaluation included fracture healing, quality of reduction, and presence of complications (e.g., infections, nerve injuries, iatrogenic clavicle or coracoid fracture, the fixation loop failure, or loss of reduction). Shoulder function was evaluated using the Constant-Murley score.Results: Patients were assessed at a mean time of 31.8 months follow-up. All 18 patients experienced radiographic union. Follow-up radiographs showed anatomical reduction in 15 patients and slight loss of reduction in 3 patients. There were 2 cases of calcification of the CC ligament, 1 case of degenerative change around the acromioclavicular (AC) joint, and 1 case of clavicular osteolysis around screws noted during the follow-up. At the final follow-up, Constant scores were 91.2 ± 6.9.Conclusions: Treating unstable distal clavicle fractures (type Ⅱb) with modified CC stabilization using LARS artificial ligament resulted in a high union rate, satisfactory fracture reduction, a low complication rate, and excellent shoulder function. We consider this simple surgical technique that naturally restores stability to the distal clavicle fracture is an efficient method for treating the fracture.

Evaluation of the modified CC stabilization using LARS artificial ligament in unstable distal clavicle fracture

Purpose: Unstable distal clavicle fracture is common, and there is no consensus regarding the gold standard treatment for this fracture. The purpose of this study was to report a new surgical technique for the treatment of unstable distal clavicle fracture with modified coracoclavicular (CC) stabilization using ligament augmentation and reconstruction system (LARS) artificial ligament, and evaluate the clinical and radiographic outcomes. Methods: From January 2009 to June 2018, eighteen patients with acute unstable distal clavicle fractures (type Ⅱb) treated by modified CC stabilization using LARS artificial ligament were retrospectively reviewed. Indexes for evaluation included fracture healing, quality of reduction, and complications (infections, nerve injuries, iatrogenic clavicle or coracoid fracture, the fixation loop failure, loss of reduction, etc.). Shoulder function was evaluated using the Constant-Murley score. Results: The patients were assessed at a mean time of 31.8 months follow-up. All 18 patients experienced radiographic union. Follow-up radiographs showed anatomical reduction in 15 patients and slight loss of reduction in 3 patients. There were 2 cases of calcification of CC ligament, 1 case of degenerative change around the acromioclavicular (AC) joint, and 1 case of clavicular osteolysis around screws noted during the follow-up. The Constant scores were 91.2 ± 6.9 at last. Conclusions: The modified CC stabilization using LARS artificial ligament resulted in a high union rate, satisfactory fracture reduction, a low complication rate, and excellent shoulder function for unstable distal clavicle fractures (type Ⅱb). We consider this simple surgical technique that naturally restores stability to the distal clavicle fracture is an efficient method for treating the fracture.

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

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.