Advertisement

LARS versus hamstring tendon autograft in anterior cruciate ligament reconstruction: a single-centre, single surgeon retrospective study with 8 years of follow-up

  • Nicola BianchiEmail author
  • Federico Sacchetti
  • Vanna Bottai
  • Marco Gesi
  • Alessio Carlisi
  • Andrea Facchini
  • Rodolfo Capanna
  • Stefano Giannotti
Original Article • KNEE - ARTHROSCOPY

Abstract

Purpose

The choice of graft type in the anterior cruciate ligament (ACL) reconstruction remains a subject of controversy. The aim of this study was to assess the outcomes in ACL reconstructions performed using a four-strand hamstring tendon graft (4SHG) or a LARS ligament comparing the effectiveness of the two grafts at a medium follow-up of 8 years.

Methods

This retrospective, single-centre, single surgeon study evaluated the clinical, functional and radiographic outcomes in 50 patients who underwent ACL reconstruction (25 4SHG and 25 LARS). Patients who underwent surgery after more than 6 months from injury and showed radiographically visible degenerative changes at time of surgery were excluded from the study.

Results

None of the patients underwent re-surgery in the same knee. The range of motion of the operated knee, compared to the contralateral, was good for both groups. The anterior drawer test resulted negative in 21 patients (84%) in the LARS group and eight patients (32%) in the 4SHG group (P = 0.039). The Lachman test was negative in 19 patients (76%) in the LARS group and in 11 patients (44%) in the 4SHG group (P = 0.045). Although other results of ACL reconstruction measured by Lysholm scores, IKDC evaluation, Tegner scores and radiographic images showed using a LARS graft tended to be superior to using a 4SHG, there were no statistically significant differences calculated.

Conclusion

Our results suggest that 4 years after ACL reconstruction using a LARS ligament or 4SHG dramatically improves the function outcome, while the patients in the LARS group displayed a higher knee stability than those in the 4SHG group.

Keywords

ACL Reconstructions Knee Sport LARS Artificial 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

References

  1. 1.
    Feller J, Webster K, Gavin B (2001) Early post-operative morbidity following anterior cruciate ligament reconstruction: patellar tendon versus hamstring graft. Knee Surg Sports Traumatol Arthrosc 9:260–266.  https://doi.org/10.1007/s001670100216 CrossRefGoogle Scholar
  2. 2.
    Weiler A, Scheffler S, Hoher J (2002) Transplant selection for primary replacement of the anterior cruciate ligament. Orthopade 31(8):731–740.  https://doi.org/10.1007/s00132-002-0331-z (in German) CrossRefGoogle Scholar
  3. 3.
    Keays S, Bullock-Saxton J, Keays A, Newcombe P (2001) Muscle strength and function before and after anterior cruciate ligament reconstruction using semitendinosus and gracilis. Knee 8:229–234.  https://doi.org/10.1016/S0968-0160(01)00099-0 CrossRefGoogle Scholar
  4. 4.
    Dericks G Jr (1995) Ligament advanced reinforcement system anterior cruciate ligament reconstruction. Oper Techn Sports Med 3:187–205.  https://doi.org/10.1016/S1060-1872(95)80009-3 CrossRefGoogle Scholar
  5. 5.
    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 7:157–163.  https://doi.org/10.1016/S0968-0160(00)00039-9 CrossRefGoogle Scholar
  6. 6.
    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 84:356–360.  https://doi.org/10.1302/0301-620X.84B3.12400 CrossRefGoogle Scholar
  7. 7.
    Trieb K, Blahovec H, Brand G, Sabeti M, Dominkus M, Kotz R (2004) In vivo and in vitro cellular ingrowth into a new generation of artificial ligaments. Eur Surg Res 36:148–151.  https://doi.org/10.1159/000077256 CrossRefGoogle Scholar
  8. 8.
    Talbot M, Berry G, Fernandes J, Ranger P (2004) Knee dislocations: experience at the Hôpital du Sacré-Coeur de Montréal. Can J Surg 47:20–24Google Scholar
  9. 9.
    Dell’Osso G, Bottai V, Bugelli G, Manisco T, Cazzella N, Celli F, Guido G, Giannotti S (2016) The biphasic bioresorbable scaffold (Trufit®) in the osteochondral knee lesions: long-term clinical and MRI assessment in 30 patients. Musculoskelet Surg 100(2):93–96CrossRefGoogle Scholar
  10. 10.
    Dell’Osso G et al (2015) Up-to-date review and cases report on chondral defects of knee treated by ACI technique: clinical–instrumental and histological results. Surg Technol Int 26:317–323Google Scholar
  11. 11.
    Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery result with special emphasis on use of scoring scale. Am J Sports Med 10:150–154CrossRefGoogle Scholar
  12. 12.
    Makhmalbaf H, Moradi A, Ganji S, Omidi-Kashani F (2013) Accuracy of Lachman and anterior drawer tests for anterior cruciate ligament injuries. Arch Bone Joint Surg 1(2):94–97Google Scholar
  13. 13.
    Petersson IF, Boegård T, Saxne T et al (1997) Radiographic osteoarthritis of the knee classified by the Ahlbäck and Kellgren and Lawrence systems for the tibiofemoral joint in people aged 35–54 years with chronic knee pain. Ann Rheum Dis 56(8):493–496CrossRefGoogle Scholar
  14. 14.
    Carter T, Edinger S (1999) Isokinetic evaluation of anterior cruciate ligament reconstruction: hamstring versus patellar tendon. Arthroscopy 15:169–172CrossRefGoogle Scholar
  15. 15.
    Beard DJ, Anderson JL, Davies S, Price AJ, Dodd CA (2001) Hamstring vs. patella tendon for anterior cruciate ligament reconstruction: a randomised controlled trail. Knee 8:45–50.  https://doi.org/10.1016/S0968-0160(01)00062-X CrossRefGoogle Scholar
  16. 16.
    Aune AK, Holm I, Risberg MA, Jensen HK, Steen H (2001) Four-strand hamstring tendon autograft compared with patellar tendon-bone autograft for anterior cruciate ligament reconstruction. A randomized study with two-year follow-up. Am J Sports Med 29:722–728CrossRefGoogle Scholar
  17. 17.
    Eriksson K, Anderberg P, Hamberg P, Löfgren AC, Bredenberg M, Westman I, Wredmark TA (2001) Comparison of quadruple semitendinosus and patellar tendon grafts in reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 83:348–354.  https://doi.org/10.1302/0301-620X.83B3.11685 CrossRefGoogle Scholar
  18. 18.
    Pinczewski LA, Deehan DJ, Salmon LJ, Russell VJ, Clingeleffer A (2002) A five-year comparison of patellar tendon versus four-strand hamstring tendon autograft for arthroscopic reconstruction of the anterior cruciate ligament. Am J Sports Med 30:523–536CrossRefGoogle Scholar
  19. 19.
    Jansson KA, Linko E, Sandelin J, Harilainen A (2003) A prospective randomized study of patellar versus hamstring tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med 31:12–18CrossRefGoogle Scholar
  20. 20.
    Otero AL, Hutcheson L (1993) A comparison of the doubled semitendinosus/gracilis and central third of the patellar tendon autografts in arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 9:143–148CrossRefGoogle Scholar
  21. 21.
    Shaieb MD, Kan DM, Chang SK, Marumoto JM, Richardson AB (2002) A prospective randomized comparison of patellar tendon versus semitendinosus and gracilis tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med 30:214–220CrossRefGoogle Scholar
  22. 22.
    Ejerhed L, Kartus J, Sernert N, Köhler K, Karlsson J (2003) Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction? A prospective randomized study with a two-year follow-up. Am J Sports Med 31:19–25CrossRefGoogle Scholar
  23. 23.
    Zarzycki W, Mazurkiewicz S, Wisniewski P (1999) Research on strength of the grafts that are used in anterior cruciate ligament reconstruction. Chir Narzadow Ruchu Ortop Pol 64:293 (in Polish) Google Scholar
  24. 24.
    Harilainen A, Sandelin J, Jansson KA (2005) Cross-pin femoral fixation versus metal interference screw fixation in anterior cruciate ligament reconstruction with hamstring tendons: results of a controlled prospective randomized study with 2-year follow-up. Arthroscopy 21(1):25–33CrossRefGoogle Scholar
  25. 25.
    Marumo K, Saito M, Yamagishi T, Fujii K (2005) The “ligamentization” process in human anterior cruciate ligament reconstruction with autogenous patellar and hamstring tendons: a biochemical study. Am J Sports Med 33(8):1166–1173CrossRefGoogle Scholar
  26. 26.
    Tegner Y, Lyshlom J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop 198:43–49Google Scholar
  27. 27.
    Randy M, Mac Donald PB (2008) Anterior cruciate ligament reconstruction: a look at prosthetics—past, present and possible future. Mcgill J Med 11:29–37Google Scholar
  28. 28.
    Fujikawa K (1988) Clinical study of anterior cruciate ligament reconstruction with Leeds Keio artificial ligament. In: Friedman MJ, Ferkel RD (eds) Prosthetic ligament reconstruction of the knee. WB Saunders Company, Philadelphia, pp 132–139Google Scholar
  29. 29.
    Boisrenoult P, Beaufils P, Brunet P, Charrois O (2005) Reconstruction of acute posterior cruciate ligament tear using a synthetic ligament. Rev Chir Orthop 91:34–43Google Scholar
  30. 30.
    Di Giovine NM, Shields CL (1991) Synthetic ligaments in ACL reconstruction: a review. Am Knee Surg 4:42–48Google Scholar
  31. 31.
    Gillquist J, Odensten M (1993) Reconstruction of old anterior cruciate ligament tears with a Dacron prosthesis: a prospective study. Am J Sports Med 21:358–366CrossRefGoogle Scholar
  32. 32.
    Bugelli G, Dell’Osso G, Ascione F, Gori E, Bottai V, Giannotti S (2018) LARS™ in ACL reconstruction: evaluation of 60 cases with 5-year minimum follow-up. Musculoskelet Surg 102:57–62CrossRefGoogle Scholar
  33. 33.
    Liu ZT, Zhang XL, Jiang Y, Zeng BF (2010) Four-strand hamstring tendon autograft versus LARS artificial ligament for anterior cruciate ligament reconstruction. Int Orthop 34(1):45–49.  https://doi.org/10.1007/s00264-009-0768-3 (Epub 2009 Apr 25) CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic and Trauma SurgeryUniversity of PisaPisaItaly
  2. 2.Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
  3. 3.Department of Orthopaedic and Trauma SurgeryUniversity of SienaSienaItaly

Personalised recommendations