| PurposeAnterior cruciate ligament(ACL)is a crucial intra-articular structure of knee joint for stability as well as easily injured.Surgery under arthroscope to reconstruct the injured ligament is the principal therapy trend internationally at present.However,which kind of graft to replace the inherent ligament is still controversy.Auto grafts have already been used widely,but the accompanying donor site complication has been puzzled the surgeons.Artificial graft seems to be a good choice as it is not harvested from a human but totally synthetic.The Ligament Augmentation & Reconstruction System(LARS?)has recently been reported to be a suitable material for ACL reconstruction.In recent years,some papers published with respect to LARS? ligament for ACL reconstruction mainly explored the clinical outcome within 24 months postoperative or compare the early/midterm follow-up with auto graft(four-strand hamstring tendon graft,4SHT or patellar tendon graft).With the paucity of long term follow-up data between autologous four hamstring tendon and LARS? ligament for ACL reconstruction,we design this retrospective study.This study evaluated 57 patients who underwent ACL reconstruction for isolated ACL rupture between 2006 and 2011,in the orthopedics department of NO.1 affiliated hospital of Dalian Medical University.MethodsThe study consisted of 57 patients who underwent ACL reconstruction for primary,isolateACL rupture between 2006 and 2011.The ACL was reconstructed with 4STG in 36 patients and with LARS? ligament in 21 patients.The minimum follow-up was 96 months,and the mean follow-up was 76±4.6 months(range: 36-98 months).There were 36 males and 21 females with a mean age of 32 years(range: 19-54 years).Time between injury and surgery within 2 weeks.All patients were evaluated using KT-2000(America,MEDmetric company)arthrometer test,International Knee Documentation Committee(IKDC)scoring systems,Lysholm knee scoring scale and Tegner activity level.All examinations and results were evaluated at follow-up by a single orthopaedic surgeon who was not involved in the patients’ care.All the surgery procedures were conducted by same group senior orthopaedic surgeons.In both groups,the remnant stump of ACL was debrided.Both groups received respective standard rehabilitation postoperatively.StatisticsAll evaluation data was analysed with SPSS 19.0 software.Normality test and homogeneity test of variance were conducted before comparing the results of two groups.The data was compared by using unpaired t-test if it is normal distribution,or it was compared by using Mann-Whitney U test.A P value of <0.05 was considered statistically significant.ResultKnee stability assessed by KT-2000 arthrometer showed that the mean side-to-side difference was 3.8±0.4 mm and 3.2±0.3 mm in the 4SHG group and LARS? group,respectively(P=0.419).The stability results showed that there was no significant difference between the two groups.In terms of Lysholm evaluation system,the mean scores were 91.36±3.66 and 92.81±2.02,(P=0.171),and the IKDC scores were 81.28±3.39 and 83.29±1.70,(P=0.213)in 4SHG group and LARS? group,and the Tegner activity scores were 4.06±0.33 and 4.33±0.36,(P=0.408),respectively.ComplicationComplications were observed in two patients(9.5%)of LARS? group,one patient had a surperficial surgery site infection within two months postoperative,which was treated with oral anti-biotics(first-generation cephalosporins)and then symptom disappeared.One graft breakage was observed in one patient who denied a new trauma during the follow-up period.And complications were observed in nine patients(25%)of 4SHG group,included seven graft breakage which five patients denied new trauma.Besides,there were two patients sustained a surperficial surgery site infection,which was treated with oral anti-biotics(first-generation cephalosporins)and then got recovery.No main complications were observed in both group,no matter infection or synovitis.Also there was no complication with respect to interface screw occurred.ConclusionThis study is a long term follow-up(minimum period 96 months)for the comparison between 4SHG and LARS? ligament for ACL reconstruction.The result revealed that LARS? ligament seem to behavior better,at least is not inferior to auto graft for ACL reconstruction in long term clinical follow-up.No higher complication rate or graft failure rate was observed in the study.Our study supports that LARS? ligament is a suitable option for injured ACL with a low complication rate and satisfactory outcome in both immediate knee stability and fast recovery after surgery.We consider that LARS? ligament is more attractive definitely to no matter athletes or revision due to its no donor site complication,immediate knee stability postoperatively and sufficient supply. |
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