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Synovitis following anterior cruciate ligament reconstruction using the LARS device

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The Ligament Augmentation and Reconstruction System (LARS®) has been at the forefront of a recent revival in the use of synthetic ligaments for ACL reconstruction. However, despite promising short-to-mid-term results its role has been approached with caution due to a high number of major complications in previous synthetic graft designs including mechanical failures, synovitis and osteoarthritis. This study aims to report on the incidence of synovitis in a series of patients undergoing second-look surgery following LARS ACL reconstruction.

Methods

A retrospective analysis was performed of a single surgeon’s series of 12 patients that underwent second-look arthroscopic surgery following primary LARS ACL surgery for indications including mechanical symptoms (meniscal tears/cyclops lesions/chondral flaps) and/or symptomatic instability secondary to LARS failure. In all cases an examination under anaesthesia (EUA) was performed, and a qualitative assessment of the synovium was carried out and graded as normal, reactive or inflammatory. A synovial biopsy was performed in all knees with visible evidence of synovitis and in all cases of LARS failure.

Results

The second-look arthroscopy was performed at a mean of 23 months (7–66) after the index surgery. In 6 (50%) knees the LARS device had failed necessitating removal and revision ACL reconstruction, while in the remaining 6 knees the LARS was still intact. Arthroscopic evaluation of the synovium revealed a normal appearance in 8 knees (67%) and reactive synovitis in 4 knees (23%); of these 4 knees, one had an intact LARS device and 3 had failed LARS. Histological examination from these 4 knees and the 3 knees with graft failures without visible synovitis revealed chronic hypertrophic synovitis (moderate 2, mild 5) in all cases with rare giant cells, consistent with a reaction to foreign body material.

Conclusions

Foreign body synovitis is a common finding in our series of patients undergoing a repeat arthroscopy following a LARS ACL reconstruction. The histological diagnosis of synovitis was more frequently encountered than an arthroscopic appearance of synovitis. Whilst the results of this case series cannot support a direct causative link between LARS failure and the development of synovitis, this study highlights the need to remain vigilant about the risk of reactive synovitis following LARS ACL reconstruction due to exposure of the knee to foreign body material.

Level of evidence

Level IV, case series.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Alfred Health, 193 Bluff Road, Sandringham, VIC, 3191, Australia

    Scott John Tulloch

  2. Epworth Hospital, 89 Bridge Road, Richmond, VIC, 3121, Australia

    Brian Meldan Devitt & Cameron John Norsworthy

  3. Melbourne Pathology, Private Bag 5, Collingwood, VIC, 3066, Australia

    Chris Mow

Authors
  1. Scott John Tulloch
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  2. Brian Meldan Devitt
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  3. Cameron John Norsworthy
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  4. Chris Mow
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Corresponding author

Correspondence to Scott John Tulloch.

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Conflict of interest

There are no conflicts of interest to declare for any authors.

Ethical approval

Ethics approval for the study was provided by the Epworth Health Care Human Research and Ethics Sub-Committee—ID # LR123-13.

Informed consent

Informed consent was obtained from all individual participants in the study.

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Tulloch, S.J., Devitt, B.M., Norsworthy, C.J. et al. Synovitis following anterior cruciate ligament reconstruction using the LARS device. Knee Surg Sports Traumatol Arthrosc 27, 2592–2598 (2019). https://doi.org/10.1007/s00167-018-5280-0

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  • DOI: https://doi.org/10.1007/s00167-018-5280-0

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