Polymers in Medicine
2016, vol. 46, nr 2, July-December, p. 155–161
doi: 10.17219/pim/68646
Publication type: original article
Language: English
Download citation:
Postoperative Knee Joint Stability Following Anterior Cruciate Ligament Reconstruction Using the Ligament Advanced Reinforcement System
1 The Center of Rehabilitation and Medical Education, Wrocław, Poland
2 The College of Physiotherapy, Wrocław, Poland
3 Department and Clinic of Traumatology and Hand Surgery, Wroclaw Medical University, Wrocław, Poland
Abstract
Background. One of the goals of the synthetic materials used in knee joint reconstruction of the anterior cruciate ligament (ACL) is to improve the strength and stability of the graft immediately after the reconstruction. One of the synthetic grafts is a non-absorbable synthetic ligament device made of terephthalic polyethylene polyester fibers, the Ligament Advanced Reinforcement System (LARS).
Objectives. The aim of the study was to assess postoperative knee joint stability in patients who had undergone ACL reconstruction using the LARS graft.
Material and Methods. The study group was comprised of 20 males who had undergone primary unilateral intraarticular ACL reconstruction using LARS. The patients were evaluated one day before the reconstruction and an average of six weeks postoperatively. Knee stability was evaluated manually using the Lachman test, anterior drawer test and pivot-shift test. Knee active range of motion (ROM) was measured.
Results. Preoperatively, the Lachman test indicated abnormal/2+ results in the vast majority of the patients. The postoperative results in most of the patients were normal/0. The anterior drawer test results were also abnormal/2+ preoperatively and normal/0 postoperatively. The pivot-shift test was positive in all of the patients before the ACL reconstruction and negative after the surgery. In general, no differences were found in the ROM between the involved and uninvolved limbs and in the between-measurement comparison.
Conclusion. The evaluation demonstrated significant progress from the preoperative to postoperative results in reducing anterior translation and anterolateral rotational instability of the tibia in patients who had undergone ACL reconstruction using the synthetic LARS graft. In the short-term follow-up assessments, restoration of anterior and anterolateral rotational stability of the operated knee joints was observed.
Key words
Lachman test, LARS, pivot-shift test, synthetic graft, terephthalic polyethylene polyester
References (31)
- Girgis F.G., Marshall J.L., Monajem A.: The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin. Orthop. Relat. Res. 1975, (106), 216–231.
- Ekstrand J.: A 94% return to elite level football after ACL surgery: a proof of possibilities with optimal caretaking or a sign of knee abuse? Knee Surg. Sports Traumatol. Arthrosc 2011, 19, 1–2. doi: 10.1007/s00167-010-1300-4.
- Risberg A.M., Lewek M., Snyder-Mackler L.: A systematic review of evidence for anterior cruciate ligament rehabilitation: how much and what type? Phys. Ther. Sport 2004, 5, 125–145. doi:10.1016/j.ptsp.2004.02.003.
- Cohen S.B., Sekiya J.K.: Allograft safety in anterior cruciate ligament reconstruction. Clin. Sports Med. 2007, 26, 597–605.
- West R.V., Harner C.D.: Graft selection in anterior cruciate ligament reconstruction. J. Am. Acad. Orthop. Surg. 2005, 13, 197–207.
- Zeng C., Gao S.G., Li H. et al.: Autograft versus allograft in anterior cruciate ligament reconstruction: A meta-analysis of randomized controlled trials and systematic review of overlapping systematic reviews. Arthroscopy 2016, 32, 153-163.e18. doi: 10.1016/j.arthro.2015.07.027.
- Samuelsson K., Andersson D., Ahldén M., Fu F.H., Musahl V., Karlsson J.: Trends in surgeon preferences on anterior cruciate ligament reconstructive techniques. Clin. Sports Med. 2013, 32, 111–126. doi: 10.1016/j.csm.2012.08.011.
- Barrera Oro F., Sikka R.S., Wolters B. et al.: Autograft versus allograft: an economic cost comparison of anterior cruciate ligament reconstruction. Arthroscopy 2011, 27, 1219–1125. doi: 10.1016/j.arthro.2011.04.008.
- Cooper M.T., Kaeding C.: Comparison of the hospital cost of autograft versus allograft soft-tissue anterior cruciate ligament reconstructions. Arthroscopy 2010, 26, 1478–1482. doi: 10.1016/j.arthro.2010.04.004.
- Norkin C.C., White D.J.: Measurement of Joint Motion: A Guide to Goniometry. F.A. Davis Company 2009, 4th ed.
- Anderson A.F., Irrgang J.J., Kocher M.S., Mann B.J., Harrast J.J: International Knee Documentation Committee: The International Knee Documentation Committee Subjective Knee Evaluation Form: normative data. Am. J. Sports Med. 2006, 34, 128–135.
- Royston P.: Remark AS R9 4: A Remark on Algorithm AS 181: The W-test for Normality. J R Stat. Soc. Series C (Appl. Stat.) 1995, 44, 547–551.
- Palmer I.: On the injuries to the ligaments of the knee joint: a clinical study. 1938. Clin. Orthop. Relat. Res. 2007, 454, 17–22.
- Abbott L.C., Saunders J.B., Bost F.C., Anderson C.E.: Injuries to the ligaments of the knee joint. J. Bone Joint Surg. Am. 1944, 26, 503–521.
- Norwood L.A., Cross M.J.: Anterior cruciate ligament: functional anatomy of its bundles in rotatory instabilities. Am. J. Sports Med. 1979, 7, 23–26.
- Amis A.A., Dawkins G.P.: Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries. J. Bone Joint Surg. Br. 1991, 73, 260–267.
- Galway H.R., MacIntosh D.L.: The lateral pivot shift: a symptom and sign of anterior cruciate ligament insufficiency. Clin. Orthop. Relat. Res. 1980, (147), 45–50.
- Trieb K., Blahovec H., Brand G., Sabeti M., Dominkus M., Kotz R.: In vivo and in vitro cellular ingrowth into a new generation of artificial ligaments. Eur. Surg. Res. 2004, 36, 148–151.
- George M.S., Dunn W.R., Spindler K.P.: Current concepts review: revision anterior cruciate ligament reconstruction. Am. J. Sports Med. 2006, 34, 2026–2037.
- Chaudhari A.M., Briant P.L., Bevill S.L., Koo S., Andriacchi T.P.: Knee kinematics, cartilage morphology, and osteoarthritis after ACL injury. Med. Sci. Sports Exerc. 2008, 40, 215–222. doi: 10.1249/mss.0b013e31815cbb0e.
- Chalmers P.N., Mall N.A., Moric M. et al.: Does ACL reconstruction alter natural history? A systematic literature review of long-term outcomes. J. Bone Joint Surg. Am. 2014, 96, 292–300. doi: 10.2106/JBJS.L.01713.
- Johnson D.: Why synthetic grafts failed. [In:] The anterior cruciate ligament: Reconstruction and basic science. Ed.: Prodromos C. Saunders Elsevier, Philadelphia 2008, 88–90.
- Bernardino S.: ACL prosthesis: any promise for the future? Knee Surg. Sports Traumatol. Arthrosc. 2010, 18, 797–804. doi: 10.1007/s00167-009-0982-y.
- Mascarenhas R., MacDonald P.B.: Anterior cruciate ligament reconstruction: a look at prosthetics – past, present and possible future. Mcgill J. Med. 2008, 11, 29–37.
- Freeman J.W., Woods M.D., Cromer D.A., Wright L.D., Laurencin C.T.: Tissue engineering of the anterior cruciate ligament: the viscoelastic behavior and cell viability of a novel braid-twist scaffold. J. Biomater. Sci. Polym. Ed. 2009, 20, 1709–1728. doi: 10.1163/156856208X386282.
- Zoltan D.J., Reinecke C., Indelicato P.A.: Synthetic and allograft anterior cruciate ligament reconstruction. Clin. Sports Med. 1988, 7, 773–784.
- Dericks G.: Ligament advanced reinforcementsystem anterior cruciate ligament reconstruction. Oper. Tech. Sports Med. 1995, 3, 187–205. doi:10.1016/S1060-1872(95)80009-3.
- Newman S.D., Atkinson H.D., Willis-Owen C.A.: Anterior cruciate ligament reconstruction with the ligament augmentation and reconstruction system: a systematic review. Int. Orthop. 2013, 37, 321–326. doi: 10.1007/s00264-012-1654-y.
- Hamido F., Misfer A.K., Al Harran H. et al.: The use of the LARS artificial ligament to augment a short or undersized ACL hamstrings tendon graft. Knee. 2011, 18, 373–378. doi: 10.1016/j.knee.2010.09.003.
- Huang J.M., Wang Q., Shen F., Wang Z.M., Kang Y.F: Cruciate ligament reconstruction using LARS artificial ligament under arthroscopy: 81 cases report. Chin. Med. J. (Engl) 2010, 123, 160–164.
- Czamara A.: Functional benchmarking of rehabilitation outcomes following anterior cruciate ligament reconstruction. Ortop. Traumatol. Rehabil. 2010, 12, 519–533.




