LARS ACL
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LARS™ACL Your questions answered

Your questions answere< First introduced in 1992, LARS ligaments are gaining popularity as an internal fixation device providing a scaffold for natural tissue in-growth. Incorporating a patented 'pre-twisted parallel fibre' concept, LARS has been designed and processed to avoid the problems faced with synthetic ligaments in the past. a) How long have LARS ligaments been available? 4 b) What data does LARS have regarding ACL reconstruction? 4 c) Aren't all synthetic ligaments the same? I have had previous failures with other PET, PP, PTFE or carbon fibre ligaments. 4 d) Is the technique for...

a) How long have LARS ligaments been available? Commercially available since 1992, LARS ligaments have been in use in countries such as the UK, France, Germany, Canada and Australia. Regulatory approval has been granted for LARS use in all countries where it has been sought. In countries where LARS is not available (e.g. the USA), it is because Corin has not yet commenced the often complex and costly regulatory procedures to secure approval in that country. b) What data does LARS have regarding ACL reconstruction? There are currently 22 published papers regarding LARS use in knee ligament...

knee movement8,9 when compared with a ‘pre-twisted parallel fibre’ design. Indeed, even the treatment of synthetic fibres post-manufacture can affect fibroblastic in-growth. LARS is chemically treated to remove an emulsion of fat enzymes that are used as a process aid during the carding and spinning of the strands which constitute the synthetic fibre. This emulsion can provoke pathological reactions in-vivo, such as synovitis and immuno-responses. This unique and thorough treatment of PET fibres is pivotal in the success of healing ACL tissue. This process has been shown to have great...

the LARS ligament will also take mechanical load from the ACL, leading to stress shielding and a neoligament of poor tissue quality. It is important to ensure that the ligament will have minimal demand for elasticity during movement; the aim being to minimise fatigue. The avoidance of intra-articular elongation, by considering the functional anatomy of the knee8, will lead to a longer lifespan. Correct positioning of the free fibres within the joint will also decrease the risk of wear8. By ensuring that the free fibres are unhindered in the intra-articular space and by positioning the woven...

e) Do LARS ACL ligaments cause synovitis? The ACL is subject not only to extension and contraction, but also to shearing and torsion. The presence of transverse fibres when ligaments are subjected to torsion may create free microparticles, or wear particles. Most early synthetic ligaments were either braided or woven in the intra-articular region; by the nature of their construction these were not designed to cope with such forces and therefore produced wear particles. It has been hypothesised that this is the primary mechanism for synovitis in the knee with synthetic ligaments23,26,27....

■■ replacement for the ACL or as an augment to an autograft as opposed to a scaffold There was a likely absence of a sufficient ACL stump (all chronic cases) and subsequent in-growth To date, no reports of increased rates of osteoarthritis have been described specifically after using a LARS ligament. g) What is the failure rate for the LARS ACL ligament and how does this compare with hamstring and patella tendon failure rates? Hamstring and patella autograft failure rates vary – recent metaanalyses demonstrate that ACL reconstructions can deliver good to excellent results in as low as 60%...

i) What other complications arise with LARS and how do these compare with autografts? As with autografts, allografts and other synthetic ligaments, some complications with LARS ligaments have been reported. The most common complications have been loosening of femoral or tibial screws and associated pain, limited flexion and/ or extension, rupture and superficial infection10,25,41,42,44. With the exception of Gäbler’s study1, reports of these complications have been remarkably low. High levels of ligament laxity (69% had >5mm Lachmann) has been reported in LARS patients in a study by Lavoie...

References 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 10 | Gäbler C, Schmidt R, Schurz M, Orthner S, Vecsei V. The introduction of an artificial ligament for reconstruction of the anterior cruciate ligament: A department’s critical review of complications and problems. Osteosynthesis and Trauma Care, 2006;14(1):51-53. Freeman JW, Kwansa AL. Recent advancements in ligament tissue engineering: the use of various techniques and materials for ACL repair. Recent Patents on Biomedical Engineering, 2008;1(1). Mascarenhas R,...

31. Feller JA. Graft choices for anterior cruciate ligament reconstruction. Cited Sept 2010, on: www.isakos.com/assets/innovations/Feller.Graft%20selection%20for%20ACL%20 Reconstruction.pdf. 32. Øiestad BE, Holm I, Engebretsen L, Risberg MA. The association between radiographic knee osteoarthritis and knee symptoms, function and quality of life 10-15 years after anterior cruciate ligament reconstruction. British Journal of Sports Medicine, 2010 Aug;16 (epub ahead of print). 33. Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J. A 10 year comparison of anterior cruciate...

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