It’s been seven years since the last systematic review of Ligament Augmentation and Reconstruction Systems so a team of researchers from Alfred Health in Melbourne, Australia decided it was time to update that review of the literature.
Their work, “The use of the Ligament Augmentation and Reconstruction System for posterior cruciate ligament reconstruction in isolated and multiligament knee injuries: a systematic review,” appears in the June 1, 2021 edition of The Knee.
Laura McDonald, an orthopedic resident at the Alfred Health and co-author explained the thinking behind this literature review. “We found a lack of up-to-date evidence regarding LARS [Ligament Augmentation and Reconstruction System] use in posterior cruciate ligament reconstruction despite many papers being published in this field in the last ten years. We decided to perform a systematic review of the most contemporary evidence in this field (as the latest review analyzing this was published seven years ago and only looked at isolated posterior cruciate ligament reconstruction in the Ligament Augmentation and Reconstruction System).”
The team selected 13 studies, all published between 2004 and 2020, to review. The mean patient follow-up for the aggregated studies was 21 months to 11.9 years and four studies had more than a 5-year follow-up.
“Regarding the use of the Ligament Augmentation and Reconstruction System for isolated PCL [posterior cruciate ligament] reconstruction,” explained Dr. McDonald to OTW, “the overall results were promising. Lysholm, IKDC [International Knee Documentation Committee], and Tegner Activity scores all increased substantially from pre- to post-operatively. Similarly, knee stability using the KT-1000 arthrometer, Telos Stress Device, or clinically via the posterior drawer test all found improved results.”
“Looking at comparative studies, one study found a more favorable improvement in posterior laxity testing in the Ligament Augmentation and Reconstruction System group compared to the hamstring tendon group, and the other two studies found improvements in both residual posterior laxity and patient-reported outcome measures for LARS and autograft groups, with no statistically significant difference between the two on follow-up. There was an overall rupture rate of the Ligament Augmentation and Reconstruction System of 2.8%, although this was reported to be symptomatic in only 1.7%.”
“The evidence for utilizing Ligament Augmentation and Reconstruction System in multiligament knee injuries remains difficult to interpret because of such confounding factors as other ligament injuries and the variability of grafts and surgical techniques used. There was also some concern for residual laxity found. Despite the residual laxity demonstrated in this review, overall patient-reported outcome measures remained satisfactory.”
Good Outcomes, Low Failure Rates, Short to Medium Term
“In terms of clinical implications, utilizing the Ligament Augmentation and Reconstruction System as a PCL graft in isolated PCL injuries appears satisfactory in the short to mid-term, with results consistent with good functional outcomes and significant improvement in knee laxity.”
“Patient-reported outcome measures and assessment of stability particularly in isolated PCL deficiency appears promising, with improved results in all measures and comparable outcomes to hamstring autograft in the three comparative studies published. The results of the Ligament Augmentation and Reconstruction System graft for PCL reconstruction in multiligament knee injuries proved more variable, with some studies demonstrating residual posterior laxity, although overall patient reported outcome measures were satisfactory.”
“Overall, the failure rate of the Ligament Augmentation and Reconstruction System in PCL reconstruction is low, with a 1.7% symptomatic failure rate in isolated PCL injuries. Furthermore, the benefits of using the Ligament Augmentation and Reconstruction System as a graft include a more aggressive rehabilitation program with a faster return to range of motion and weight bearing, and a shorter return to sport time, along with no donor site morbidity or disease transmission.”
“Although these results demonstrate that PCL reconstruction using a Ligament Augmentation and Reconstruction System graft—particularly in isolated PCL reconstruction—is safe and effective in the short to medium term, there remains a paucity of high-level evidence available on this topic and future research should include comparative studies and randomised control trials over a longer follow-up period particularly given late failure rates noted from synthetic ligaments in the past.”
