ACL Replacement with Synthetic vs. Biological Tendon Grafts: Long-Term Follow-Up Comparison Using Objective Evaluations.

BACKGROUND AND AIM OF THE STUDY: Anterior cruciate ligament (ACL) tears are among the most common articular injuries in sports and can be responsible for knee instability and reduced articular performance. Treatment can be either conservative or operative, and ligament reconstruction may be carried out using biological autologous grafts or synthetic materials. Several studies have sought to evaluate and compare functional results in treated patients. However, there is still very limited information available on long-term follow-up and clinical outcomes are generally evaluated only using subjective scores. In this study, we assessed long-term functional and biomechanical results in patients treated with biologic and synthetic ligaments using objective measures. MATERIALS AND METHODS: Patients were divided according to whether ACL reconstruction was biologic or synthetic. The Tegner activity scale was used before and after surgery. Post-operative subjective scores such as the IKDC Questionnaire and the Tegner-Lysholm score were also recorded. The Y Balance Test was used to assess global stability and mobility of the lower limb. Kinematic Rapid Assessment (KiRA) was used to evidence and estimate ligamentous laxity during the Pivot Shift and Lachman tests. RESULTS: Clinical subjective patient and operator-dependent scores as well as objective biomechanical findings were similar and comparable in patients treated with biologic and synthetic reconstructions after more than 10 years of use. CONCLUSIONS: Both synthetic and biological tendon grafts may represent good reconstructive approaches to treat torn ACLs, and remain effective even for a long period of time if implanted in suitable target patients.

Anterior cruciate ligament reconstruction with LARS™ artificial ligament results at a mean follow-up of eight years.

PURPOSE: The aim of this study was to review patients that underwent ACL reconstruction with the LARS™ ligament in the First Orthopaedic Division of Pisa University during the period between January 2003 and December 2005. METHODS: Twenty-six patients were reviewed with an average follow-up of 95.3 months (7.9 years). The review protocol was articulated in three phases: (1) a subjective evaluation using three grading scales: VAS, KOOS and the Cincinnati knee rating scale, (2) a clinical and objective evaluation, and (3) a biomechanical evaluation of the knee stability. RESULTS: A global positive result was obtained in 92.3 % of the patients (16 optimal results and eight good results), with a fast functional recovery and a high knee stability. A global poor result was reported in two cases. In our series we did not record cases of infection or knee synovitis. We recorded only one case of mechanical graft failure. The results obtained from our study are encouraging and similar to those in the literature. CONCLUSIONS: We conclude that the LARS™ ligament can be considered a suitable option for ACL reconstruction in carefully selected cases, especially for older patients needing a fast functional recovery.

Anterior Cruciate Ligament Reconstruction with LARS Artificial Ligament-Clinical Results after a Long-Term Follow-Up.

Purpose The aim of this retrospective study was to evaluate the subjective and functional outcome of anterior cruciate ligament (ACL) reconstruction with the synthetic Ligament Advanced Reinforcement System (LARS) ligament. Methods Twenty-six patients were reviewed at an average follow-up of 11.6 years. Objective clinical evaluation was performed with stability tests. Patient-reported outcomes (Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score, and Cincinnati Knee Rating Scale) were used to assess subjective and functional outcomes. Results Overall satisfactory results were obtained in 22 cases (84.6%). Four patients (15.4%) showed mechanical failure of the graft. No cases of synovitis or infection were reported. Conclusion LARS ligament can be considered a safe and suitable option for ACL reconstruction in carefully selected cases, especially elderly patients needing a rapid postoperative recovery. Level of Evidence Level IV, retrospective case series.