Abstract
Purpose
The Ligament Augmentation and Reconstruction System (LARS) is a third generation of synthetic ligament, designed to overcome the issues of graft failure and synovitis which led previous generations of synthetic ligaments to fall out of favour. The theoretical benefits of LARS are appealing but this has not led to widespread uptake of the system in preference to autograft. The aim of this systematic review is to assess whether the evidence exists to support the use of LARS with respect to outcomes and complications.
Methods
A systematic search process was undertaken from January 1990 to June 2012 to identify primary evidence relating to the use of LARS in anterior cruciate ligament (ACL) single ligament reconstruction.
Results
Nine studies were found meeting the search criteria including a single randomised controlled trial, two comparative series and six further observational case series. Overall the methodological quality of the studies was poor with follow-up to a maximum of five years. Reported outcome scores were good for LARS and comparable to autograft techniques. Complication rates were low and comparable to those published for autograft techniques within the wider literature. Two reported incidences of synovitis were identified in case reports.
Conclusions
The current literature supports the use of LARS in the short to medium term. However, high-quality studies with long-term follow-up are required to determine whether the use of LARS is preferable to autograft for ACL reconstruction over the longer term. Synovitis appears to be a rare complication closely related to imperfect graft positioning.
Similar content being viewed by others
References
Ventura A, Terzaghi C, Legnani C, Borgo E, Albisetti W (2010) Synthetic grafts for anterior cruciate ligament rupture: 19-year outcome study. Knee 17(2):108–113
Yamamoto H, Ishibashi T, Muneta T, Furuya K, Mizuta T (1992) Effusions after anterior cruciate ligament reconstruction using the ligament augmentation device. Arthroscopy 8(3):305–310
Downs S, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 52:377–384
Phillips R, Ball C, Sackett D (2009) Oxford centre for evidence based medicine—levels of evidence. http://www.cebm.net/index.aspx?o=1025. Accessed 15 May 2012
Hamido F, Misfer KA, Al Harran H et al (2011) The use of the LARS artificial ligament to augment a short or undersized ACL hamstrings tendon graft. Knee 18(6):373–378
Gao K, Chen S, Wang L et al (2010) Anterior cruciate ligament reconstruction with LARS artificial ligament: a multicenter study with 3- to 5-year follow-up. Arthroscopy 26(4):515–523
Liu Z, Zhang X, Jiang Y, Zeng B-F et al (2010) Four-strand hamstring tendon autograft versus LARS artificial ligament for anterior cruciate ligament reconstruction. Int Orthop 34(1):45–49
Huang J, Wang Q, Shen F, Wang Z, Kang Y (2010) Cruciate ligament reconstruction using LARS artificial ligament under arthroscopy: 81 cases report. Chin Med J (Engl) 123(2):160–164
Fan Q, Fan J (2008) Comparison between four-strand semitendinosus tendon autograft and ligament advanced reinforcement system for anterior cruciate ligament reconstruction by arthroscopy. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 22(6):676–679
Cerulli G (2007) ACL reconstruction using artificial ligaments: five years follow-up. SIOT 33(3 Suppl 1):8238–8242
Nau T, Lavoie P, Duval N (2002) A new generation of artificial ligaments in reconstruction of the anterior cruciate ligament. Two-year follow-up of a randomised trial. J Bone Joint Surg Br 84(3):356–360
Lavoie P, Fletcher J, Duval N (2000) Patient satisfaction needs as related to knee stability and objective findings after ACL reconstruction using the LARS artificial ligament. Knee 7(3):157–163
Dericks G (1995) Ligament advanced reinforcement system anterior cruciate ligament reconstruction. Oper Tech Sports Med 3(3):187–205
Laboute E, Savalli L, Puig P et al (2010) Analysis of return to competition and repeat rupture for 298 anterior cruciate ligament reconstructions with patellar or hamstring tendon autograft in sportspeople. Ann Phys Rehabil Med 53(10):598–614
Mihelic R, Jurdana H, Jotanovic Z, Madjarevic T, Tudor A (2011) Long-term results of anterior cruciate ligament reconstruction: a comparison with non-operative treatment with a follow-up of 17–20 years. Int Orthop 35(7):1093–1097
Wright RW, Magnussen RA, Dunn WR, Spindler KP (2011) Ipsilateral graft and contralateral ACL rupture at five years or more following ACL reconstruction: a systematic review. J Bone Joint Surg Am 93(12):1159–1165
Li H, Yao Z, Jiang J et al (2012) Biologic failure of a ligament advanced reinforcement system artificial ligament in anterior cruciate ligament reconstruction: a report of serious knee synovitis. Arthroscopy 28(4):583–586
Glezos CM, Waller A, Bourke HE, Salmon LJ, Pinczewski LA (2012) Disabling synovitis associated with LARS artificial ligament use in anterior cruciate ligament reconstruction: a case report. Am J Sports Med 40(5):1167–1171
Barenius B, Nordlander M, Ponzer S, Tidermark J, Eriksson K (2010) Quality of life and clinical outcome after anterior cruciate ligament reconstruction using patellar tendon graft or quadrupled semitendinosus graft: an 8-year follow-up of a randomized controlled trial. Am J Sports Med 38(8):1533–1541
Biau DJ, Tournoux C, Katsahian S, Schranz PJ, Nizard RS (2006) Bone-patellar tendon-bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta-analysis. BMJ 332(7548):995–1001
Holm I, Oiestad BE, Risberg MA, Aune AK (2010) No difference in knee function or prevalence of osteoarthritis after reconstruction of the anterior cruciate ligament with 4-strand hamstring autograft versus patellar tendon-bone autograft: a randomized study with 10-year follow-up. Am J Sports Med 38(3):448–454
Mastrokalos DS, Springer J, Siebold R et al (2005) Donor site morbidity and return to the preinjury activity level after anterior cruciate ligament reconstruction using ipsilateral and contralateral patellar tendon autograft: a retrospective, nonrandomized study. Am J Sports Med 33(1):85–93
Sajovic M, Strahovnik A, Dernovsek MZ, Skaza K (2011) Quality of life and clinical outcome comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: an 11-year follow-up of a randomized controlled trial. Am J Sports Med 39(10):2161–2169
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Newman, S.D.S., Atkinson, H.D.E. & Willis-Owen, C.A. Anterior cruciate ligament reconstruction with the ligament augmentation and reconstruction system: a systematic review. International Orthopaedics (SICOT) 37, 321–326 (2013). https://doi.org/10.1007/s00264-012-1654-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-012-1654-y