Primary ACL reconstruction using the LARS device is associated with a high failure rate at minimum of 6-year follow-up
The Ligament Augmentation and Reconstruction System (LARS®) is a synthetic ligament consisting of fibres made of polyethylene terephthalate. Despite the LARS being used as an anterior cruciate ligament (ACL) device for nearly 30 years and the well-documented complications from earlier synthetic ligament designs, there is a paucity of published medium- to long-term results. The aim of this study is to report the clinical and functional outcomes after ACL reconstruction using the LARS at a minimum follow-up of 6 years.
Results of a single surgeon’s entire cohort of 55 patients who underwent primary LARS ACL surgery were reviewed at a median of 7.8 years (6.0–9.4). Patient-reported outcome measures including the International Knee Documentation Committee (IKDC) score and 36-Item Short Form Health Survey (SF-36) were collected and clinical assessment consisted of range of motion (ROM) and the KT-1000 arthrometer to assess the side–side difference in the operative and non-operative knee. Mechanical failures of the graft were confirmed at revision surgery and a survivorship analysis was performed using the Kaplan–Meier method.
The overall mechanical failure rate was 17/51 (33.3%) with ruptures occurring at a median 3.9 years (0.6–8.8 years) following primary LARS ACL surgery. Secondary operative procedures were performed in 39.2% of patients. For intact grafts, there was no statistically significant difference is side-to-side ROM or anterior knee laxity and subjective scores revealed a median IKDC subjective score of 85.1 (26.4–100) and SF-36 physical component score of 94.1.
The rates of LARS ACL construct failure (33.3%) in this cohort are high and based on these results the LARS should not be considered as a graft option for primary ACL reconstruction.
Level of evidence
III, cohort study.
KeywordsLARS Ligament Augmentation and Reconstruction System ACL Anterior cruciate ligament Knee ligament Synthetic ligament Synthetic graft Knee Sports knee Knee surgery Reconstruction ACL reconstruction
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
Ethics approval for the study was provided by the Epworth Health Care Human Research and Ethics Sub-Committee—reference number LR246-15.
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