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Functional and MRI results after a 7.5 year follow-up of 35 single-stage ACL and PCL reconstructions using gracilis and semitendinosus tendon grafts and LARS artificial ligaments

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Abstract

Purpose

The aim of this study was to evaluate the long-term functional and MRI results of 35 patients who underwent bicruciate ligament reconstruction combining an ACL autograft using the gracilis and semitendinosus tendons and double-bundle PCL reconstruction using the LARS artificial ligament.

Methods

The outcomes were measured using the Lysholm score, the Tegner activity level scale and the International Knee Documentation Committee form (IKDC 2000). KT-1000 was used to assess the clinical anterior knee laxity. Radiographs and Magnetic Resonance Imaging (MRI) was used to evaluate osteoarthritis, the continuity and integrity of ACL autograft and LARS.

Results

This retrospective study examined 35 patients who underwent single-stage bicruciate ligament reconstruction between May 2005 and January 2017 with a follow-up period ranging from 3 to 15 years (a mean of 7.5 years). The mean Lysholm score was 74, mean IKDC 2000 was 71. There was a statistically significant difference with a higher Lysholm score (78.9) in early versus delayed surgical intervention (p = 0.023). Using the Kellgren Lawrence osteoarthritis classification system, radiographic findings showed stage II or III in 83% of the sample population. The MRI results revealed a rupture rate of 22% of the anterior autografted ligament and 28% of the posterior LARS artificial ligament. However, there were no long-term artificial ligament-induced complications. There was no correlation between artificial ligament rupture and poor functional results (Lysholm < 65).

Conclusion

The results of this study with a mean follow-up of 7.5 years show satisfactory functional scores considering the initial trauma. It seems reasonable to propose early surgical treatment with double reconstruction of the cruciate ligaments within the first 21 days of the trauma. Post-traumatic osteoarthritis is inevitable in multi-ligament knee injuries despite anatomical reconstruction. The use of a LARS artificial ligament appears to be a valid alternative for PCL reconstruction in the context of multi-ligament injury and in the absence of sufficient autologous transplants.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon request.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Orthopedics and Sport Surgery, Grenoble-Alpes CHU, South Teaching Hospital, Kimberley Avenue, BP 338, 38434, Échirolles Cedex, France

    Valentin Merle du Bourg, Benoit Orfeuvre, Benoit Gaulin, Loic Sigwalt, Clément Horteur & Brice Rubens-Duval

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  1. Valentin Merle du Bourg
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  2. Benoit Orfeuvre
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  3. Benoit Gaulin
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  4. Loic Sigwalt
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  6. Brice Rubens-Duval
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Merle du Bourg Valentin, Orfeuvre Benoit, Gaulin Benoit, Sigwalt Loic, Horteur Clément and Rubens-Duval Brice. The first draft of the manuscript was written by Merle du Bourg Valentin and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Valentin Merle du Bourg.

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Ethical approval

Ethical approval was waived by the local Ethics Committee of CNIL in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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

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The authors affirm that human research participants provided informed consent for publication of the images in Figs. 3, 4a, b

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Merle du Bourg, V., Orfeuvre, B., Gaulin, B. et al. Functional and MRI results after a 7.5 year follow-up of 35 single-stage ACL and PCL reconstructions using gracilis and semitendinosus tendon grafts and LARS artificial ligaments. Eur J Orthop Surg Traumatol 34, 1163–1172 (2024). https://doi.org/10.1007/s00590-023-03774-w

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