Subscribe to RSS
DOI: 10.1055/s-2006-921367
© Georg Thieme Verlag Stuttgart · New York
The Introduction of an Artificial Ligament for Reconstruction of the Anterior Cruciate Ligament: A Department's Critical Review of Complications and Problems
Publication History
Publication Date:
02 March 2006 (online)
Abstract
Background: We reviewed the results of anterior cruciate ligament reconstruction using the Ligament Advanced Reinforcement System (LARS). The aim of the study was to analyze the outcome. Methods: From 2000 to 2002 26 patients with an acute rupture of the anterior cruciate ligament were operated using the LARS ligament and underwent a routine examination at a minimum of one year after surgery. The follow-up sheets of these clinical controls were analyzed. Results: Eleven patients (42.3 %) required a reoperation. Another seven patients (27 %) complained either of massive loss of flexion, extension deficit, persistent pain or persisting anterior knee instability with giving way attacks, however, they declined to undergo a reoperation. Two infections occurred (8 %). This left us with a 69 % rate of postoperative problems and complications. Another four patients (15.4 %) had knee laxity (Lachmann positive), but no subjective instability problems. Conclusion: The main reason for this high rate of complications might be the inhomogeneous group of nine different surgeons with varying levels of experience. The complication rate also represents the learning curve of the unit. However, we do not suggest using this artificial ligament for routine operations of the anterior cruciate ligament due to the high rate of postoperative problems and complications.
Key words
anterior cruciate ligament - reconstruction - synthetic augmentation - knee - arthroscopy
References
- 1 Dahlstedt L, Dalen N, Jonsson U. Goretex prosthetic ligament vs. Kennedy ligament augmentation device in anterior cruciate ligament reconstruction. A prospective randomized 3-year follow-up of 41 cases. Acta Orthop Scand. 1990; 61 217-224
- 2 Dericks G. Ligament advanced reinforcement system anterior cruciate ligament reconstruction. Op Tech Sports Med. 1995; 3 187-205
- 3 DiGiovine N M, Shields C L. Synthetic ligaments in ACL reconstruction: a review. Am J Knee Surg. 1991; 4 42-48
- 4 Drogset J O, Grontvedt T. Anterior cruciate ligament reconstruction with and without a ligament augmentation device. Results at 8-year follow-up. Am J Sports Med. 2002; 30 851-856
- 5 Ejerhed L, Kartus J, Semert N, Kohler K, Karlsson J. 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. 2003; 31 19-25
-
6 Feagin J A. Physical Examination of the Knee. In: Garret WE, Speer KP, Kirkendall DT (eds). Principles and Practice of Orthopaedic Sports Medicine. Lippincott Williams and Wilkins, Philadelphia 2000; 613-622
- 7 Feller J A, Webster K E. A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. Am J Sports Med. 2003; 31 564-573
- 8 Grontvedt T, Engebretsen L, Benum P, Fasting D, Molster A, Strand T. A prospective, randomized study of three operations for acute rupture of the anterior cruciate ligament. Five-year-follow-up of one hundred and thirty-one patients. J Bone Joint Surg [Am]. 1996; 78 159-168
- 9 Kiefer H, Richter M, Hehl G. Augmentationstechniken: Sind sie out?. Zentralbl Chir. 1998; 123 1002-1013
- 10 Hurley M V. The effects of joint damage on muscle function, proprioception and rehabilitation. Man Ther. 1997; 2 11-17
- 11 Jansson K A, Linko E, Sandelin J, Harilainen A. A prospective randomized study of patellar versus hamstring tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med. 2003; 31 12-18
- 12 Kartus J, Movin T, Karlsson J. Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts. Arthroscopy. 2001; 17 971-980
- 13 Katayama M, Higuchi H, Kimura M, Kobayashi A, Hatayarna K, Terauchi M, Takagishi K. Proprioception and performance after anterior cruciate ligament rupture. Int Orthop. 2004; 28 278-281
- 14 Kennedy J C, Roth J U, Mendenhall H V, Sanford J B. Intraarticular replacement in the anterior cruciate ligament-deficient knee. Am J Sports Med. 1980; 8 1-8
- 15 Kumar K, Maffuli N. The ligament augmentation device: An historical perspective. J Arthrosc Rel Surg. 1999; 15 422-432
- 16 Lobenhoffer P, Tscherne H. Die Ruptur des vorderen Kreuzbandes. Heutiger Behandlungsstand. Unfallchirurg. 1993; 96 150-168
- 17 MacDonald P B, Hedden D, Pacin O, Sutherland K. Proprioception in anterior cruciate ligament-deficient and reconstructed knees. Am J Sports Med. 1996; 24 774-778
- 18 Mendenhall H V, McPherson G F, Gibbons D F, Plenk H, Rottmann W, Sanford J B, Grussing D M, Kennedy J C. Evaluation of the ligament augmentation device after two year implantation in goats. Proc Soc Biomaterials. 1983; 59 6
- 19 Muren O, Dahlstedt L, Dalen N. Reconstruction of acute anterior cruciate ligament injuries: a prospective randomised study of 40 patients with 7-year follow-up. Arch Orthop Trauma Surg. 2003; 123 144-147
- 20 Nau T, Lavoie P, Duval N. A new generation of artificial ligaments in reconstruction of the anterior cruciate ligament. Two year follow-up of a randomized trial. J Bone Joint Surg [Br]. 2002; 84 356-360
-
21 Strobel M J. Manual of Arthroscopic Surgery. Springer, Berlin, New York, Tokio 1998; 367-570
- 22 Svensson M, Kartus J, Ejerhed L, Lindahl S, Karlsson J. Does the patellar tendon normalize after harvesting its central third?. Am J Sports Med. 2004; 32 34-38
- 23 Torg J S, Conrad W, Kalen V. Clinical diagnosis of anterior cruciate ligament instability of the athlete. Am J Sports Med. 1976; 4 84-93
- 24 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
Prof. Dr. C. GäblerM. D., PhD
Department of Traumatology · University of Vienna Medical School
Währinger Gürtel 18-20
1090 Wien
Austria
Email: christian.gaebler@meduniwien.ac.at