A case report of traumatic osteoarthritis associated with LARS artificial ligament use in anterior cruciate ligament rec
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CASE REPORT
Open Access
A case report of traumatic osteoarthritis associated with LARS artificial ligament use in anterior cruciate ligament reconstruction Yuanliang Du, Haifeng Dai, Zhihui Wang, Di Wu, Changjiang Shi, Tianjie Xiao and Zhihuai Li*
Abstract Background: A ligament advanced reinforcement system (LARS) artificial ligament has been proposed for use in anterior cruciate ligament (ACL) reconstruction, and many reports have shown its success in ACL reconstruction. However, there are great concerns about the potential risk of complications, which might prevent its extensive use. Late failure may occur due to serious complications. Case presentation: We report a rare case of serious osteoarthritis that occurred 2 years postoperatively in a 51year-old man who underwent reconstruction with an LARS artificial ligament. In X-rays, the tibial tunnel was placed too posteriorly. MRI showed that the tibial tunnel was enlarged, and there was a large effusion in the knee joint. The LARS device was rough and worn. Histologically, a large number of fibroblasts and a few multinucleated giant cells infiltrated the graft fibres. Conclusion: Our findings remind surgeons that an LARS device should be with great caution in ACL reconstruction. Keywords: Anterior cruciate ligament, ACL, Ligament advanced reinforcement system, LARS, Osteoarthritis, Ligament reconstruction
Background Anterior cruciate ligament (ACL) injury is the most common reason for knee instability, and injuries to the ligament may lead to osteoarthritis and other degenerative joint disease [1, 2]. For patients eager to achieve orthobiosis, the most effective treatments for ACL injury are reconstruction of the ligament and postoperative physiotherapeutic procedures [3]. Reconstruction of the ligament could be conducive to knee stability and, in turn, reduce the risk of secondary injuries [4, 5]. A variety of grafts are available for use in ACL reconstruction surgery, such as allografts and synthetic ligaments. The use of allograft autografts are the first option in ACL* Correspondence: [email protected] Department of Joint Surgery, Affiliated Hospital of Chengde Medical University, No.36 Nanyingzi Street, Chengde, Heibei Province, China
reconstruction in recent years with the attraction of absent donor site morbidity [6]. The ligament advanced reinforcement system (LARS), a synthetic, nonabsorbable augmentation device made of polyethylene terephthalate (PET), has been also widely used in many countries [7]. With the aim of removing potential machining residues and oils, the LARS is intensively cleaned to further encourage soft tissue in-growth and reduce the risk of reactive synovitis [8]. In a recent study, the medium-term clinical outcomes of ACL reconstruction using an LARS artificial ligament were assessed, and among all patients enrolled in the study, the failure rate was 4.4%, with an overall complication rate of 2.2% [9]. Although these preliminary clinical investigations have shown encouraging results, there is concern that late failure may
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