Effectiveness comparison of LARS artificial ligament and autogenous hamstring tendon in one-stage reconstruction of anterior and posterior cruciate ligaments_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Yu ^1,2 , ZHANG Hao ³ , XIAO Shizhuo ¹ , ZHENG Qiu ¹ , ZENG Yalan ¹ ,  YANG Hongbin ¹

1. Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;
2. Department of Orthopedics, the First People’s Hospital of Yibin, Yibin Sichuan, 644000, P.R.China;
3. Department of Orthopedics, People’s Hospital of Linshui, Linshui Sichuan, 638500, P.R.China;

Corresponding author：

YANG Hongbin, Email: yanghongbin1234@163.com

Keywords：

Arthroscopy; LARS artificial ligament; autogenous hamstring tendon; anterior cruciate ligament; posterior cruciate ligament; joint function reconstruction

DOI：

10.7507/1002-1892.201908051

Video：

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Objective To compare the effectiveness of arthroscopic one-stage reconstruction of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) with LARS artificial ligament and autogenous hamstring tendon, respectively.Methods A retrospective study was performed on 23 patients with ACL and PCL injuries, who were treated with one-stage reconstruction, between June 2013 and June 2017. The ACL and PCL were reconstructed with LARS artificial ligament in 11 patients (artificial ligament group) and autogenous hamstring tendon in 12 patients (autogenous tendon group). There was no significant difference in gender, age, side of injury, cause of injury, time from injury to operation, and preoperative Lysholm score and International Knee Documentation Committee (IKDC) score between the two groups (P>0.05). The operation time, the time of recovery of daily activities and preoperative exercise level, the occurrence of surgical-related complications, Lysholm score, IKDC score, and the results of knee stability assessment were recorded and compared between the two groups.Results The operation time and the time of recovery of daily activities and preoperative exercise level were significantly shorter in artificial ligament group than in autogenous tendon group (P<0.05). All incisions healed primarily. In autogenous tendon group, the common fibular nerve injury occurred in 1 case and intermuscular vein thrombosis occurred in 1 case. No complication occurred in the remaining patients of the two groups. All the patients were followed up 24-54 months (mean, 36.4 months). At last follow-up, the Lysholm score and IKDC score of the two groups were significantly higher than preoperative scores (P<0.05). There was no significant difference between the two groups (P>0.05). The varus and valgus stress tests of the two groups were negative. There was no significant difference in anterior drawer test, posterior drawer test, and Lachman test between the two groups (P>0.05).Conclusion The effectiveness of arthroscopic one-stage reconstruction of ACL and PCL with LARS artificial ligament or autogenous hamstring tendon was similar. The knee function and stability recover well. But the patients with LARS artificial ligament reconstruction can resume daily activities and return to exercise earlier.

Citation： LI Yu, ZHANG Hao, XIAO Shizhuo, ZHENG Qiu, ZENG Yalan, YANG Hongbin. Effectiveness comparison of LARS artificial ligament and autogenous hamstring tendon in one-stage reconstruction of anterior and posterior cruciate ligaments. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(8): 1018-1024. doi: 10.7507/1002-1892.201908051 Copy

1.	Denti M, Tornese D, Melegati G, et al. Combined chronic anterior cruciate ligament and posterior cruciate ligament reconstruction: functional and clinical results. Knee Surg Sports Traumatol Arthrosc, 2015, 23(10): 2853-2858.
2.	Zheng L, Sabzevari S, Marshall B, et al. Anterior cruciate ligament graft fixation first in anterior and posterior cruciate ligament reconstruction best restores knee kinematics. Knee Surg Sports Traumatol Arthrosc, 2018, 26(4): 1237-1244.
3.	Panigrahi R, Kumari Mahapatra A, Priyadarshi A, et al. Outcome of simultaneous arthroscopic anterior cruciate ligament and posterior cruciate ligament reconstruction with hamstring tendon autograft: A multicenter prospective study. Asian J Sports Med, 2016, 7(1): e29287.
4.	Ohkoshi Y, Nagasaki S, Shibata N, et al. Two-stage reconstruction with autografts for knee dislocations. Clin Orthop Relat Res, 2002, (398): 169-175.
5.	Stannard J, Bauer KL. Current concepts in knee dislocations: PCL, ACL, and medial sided injuries. J Knee Surg, 2012, 25(4): 287-294.
6.	白晓东, 王耀霆, 车琦, 等. 膝关节镜全内技术自体腘绳肌腱移植一期重建前、后十字韧带断裂. 中华骨科杂志, 2018, 38(17): 1045-1054.
7.	陈蓟, 刘弼. LARS 人工韧带关节镜下一期同时重建前、后交叉韧带的近期疗效分析. 中华创伤骨科杂志, 2017, 19(8): 727-729.
8.	Buyukdogan K, Laidlaw MS, Miller MD. Surgical management of the multiple-ligament knee injury. Arthrosc Tech, 2018, 7(2): e147-e164.
9.	Woodmass JM, Johnson NR, Mohan R, et al. Poly-traumatic multi-ligament knee injuries: is the knee the limiting factor? Knee Surg Sports Traumatol Arthrosc, 2018, 26(9): 2865-2871.
10.	Sun L, Wu B, Tian M, et al. Results of multiple ligament injured knees operated by three different strategies. Indian J Orthop, 2016, 50(1): 43-48.
11.	孔颖, 王雷, 张元民, 等. 关节镜下保留残端自体腘绳肌腱同期单束重建前后交叉韧带疗效观察. 中国矫形外科杂志, 2015, 23(2): 113-118.
12.	Sanders TL, Johnson NR, Levy NM, et al. Effect of vascular injury on functional outcome in knees with multi-ligament injury. J Bone Joint Surg (Br), 2017, 99(18): 1565-1571.
13.	代朋乙, 黄昌林. 关节镜下一期修复重建膝关节多发韧带损伤的疗效观察. 解放军医学杂志, 2019, 44(1): 57-62.
14.	李书振, 王豪, 韩杰, 等. 关节镜下早期与晚期自体肌腱重建前交叉韧带的对比研究. 中国组织工程研究, 2019, 23(26): 4170-4174.
15.	孙正宇, 张承昊, 唐新, 等. 一期修复重建膝关节脱位多发韧带损伤的疗效观察. 中国修复重建外科杂志, 2016, 30(6): 690-694.
16.	刘华, 狄正林, 章军辉, 等. 关节镜下一期自体腘绳肌腱重建前交叉韧带联合 LARS 韧带重建后交叉韧带. 中国骨与关节损伤杂志, 2014, 29(12): 1227-1229.
17.	Bianchi N, Sacchetti F, Bottai V, et al. LARS versus hamstring tendon autograft in anterior cruciate ligament reconstruction: a single-centre, single surgeon retrospective study with 8 years of follow-up. Eur J Orthop Surg Trauma, 2019, 29(2): 447-453.
18.	Cantivalli A, Rosso F, Bonasia DE, et al. High tibial osteotomy and anterior cruciate ligament reconstruction/revision. Clin Sports Med, 2019, 38(3): 417-433.
19.	Dejour D, Saffarini M, Demey G, et al. Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture. Knee Surg Sports Traumatol Arthrosc, 2015, 23(10): 2846-2852.
20.	柳海峰, 陆伟, 梁达强, 等. 大腿肌群等速训练对前交叉韧带重建术后移植物塑形的影响. 中国修复重建外科杂志, 2019, 33(9): 1088-1094.

1. Denti M, Tornese D, Melegati G, et al. Combined chronic anterior cruciate ligament and posterior cruciate ligament reconstruction: functional and clinical results. Knee Surg Sports Traumatol Arthrosc, 2015, 23(10): 2853-2858.
2. Zheng L, Sabzevari S, Marshall B, et al. Anterior cruciate ligament graft fixation first in anterior and posterior cruciate ligament reconstruction best restores knee kinematics. Knee Surg Sports Traumatol Arthrosc, 2018, 26(4): 1237-1244.
3. Panigrahi R, Kumari Mahapatra A, Priyadarshi A, et al. Outcome of simultaneous arthroscopic anterior cruciate ligament and posterior cruciate ligament reconstruction with hamstring tendon autograft: A multicenter prospective study. Asian J Sports Med, 2016, 7(1): e29287.
4. Ohkoshi Y, Nagasaki S, Shibata N, et al. Two-stage reconstruction with autografts for knee dislocations. Clin Orthop Relat Res, 2002, (398): 169-175.
5. Stannard J, Bauer KL. Current concepts in knee dislocations: PCL, ACL, and medial sided injuries. J Knee Surg, 2012, 25(4): 287-294.
6. 白晓东, 王耀霆, 车琦, 等. 膝关节镜全内技术自体腘绳肌腱移植一期重建前、后十字韧带断裂. 中华骨科杂志, 2018, 38(17): 1045-1054.
7. 陈蓟, 刘弼. LARS 人工韧带关节镜下一期同时重建前、后交叉韧带的近期疗效分析. 中华创伤骨科杂志, 2017, 19(8): 727-729.
8. Buyukdogan K, Laidlaw MS, Miller MD. Surgical management of the multiple-ligament knee injury. Arthrosc Tech, 2018, 7(2): e147-e164.
9. Woodmass JM, Johnson NR, Mohan R, et al. Poly-traumatic multi-ligament knee injuries: is the knee the limiting factor? Knee Surg Sports Traumatol Arthrosc, 2018, 26(9): 2865-2871.
10. Sun L, Wu B, Tian M, et al. Results of multiple ligament injured knees operated by three different strategies. Indian J Orthop, 2016, 50(1): 43-48.
11. 孔颖, 王雷, 张元民, 等. 关节镜下保留残端自体腘绳肌腱同期单束重建前后交叉韧带疗效观察. 中国矫形外科杂志, 2015, 23(2): 113-118.
12. Sanders TL, Johnson NR, Levy NM, et al. Effect of vascular injury on functional outcome in knees with multi-ligament injury. J Bone Joint Surg (Br), 2017, 99(18): 1565-1571.
13. 代朋乙, 黄昌林. 关节镜下一期修复重建膝关节多发韧带损伤的疗效观察. 解放军医学杂志, 2019, 44(1): 57-62.
14. 李书振, 王豪, 韩杰, 等. 关节镜下早期与晚期自体肌腱重建前交叉韧带的对比研究. 中国组织工程研究, 2019, 23(26): 4170-4174.
15. 孙正宇, 张承昊, 唐新, 等. 一期修复重建膝关节脱位多发韧带损伤的疗效观察. 中国修复重建外科杂志, 2016, 30(6): 690-694.
16. 刘华, 狄正林, 章军辉, 等. 关节镜下一期自体腘绳肌腱重建前交叉韧带联合 LARS 韧带重建后交叉韧带. 中国骨与关节损伤杂志, 2014, 29(12): 1227-1229.
17. Bianchi N, Sacchetti F, Bottai V, et al. LARS versus hamstring tendon autograft in anterior cruciate ligament reconstruction: a single-centre, single surgeon retrospective study with 8 years of follow-up. Eur J Orthop Surg Trauma, 2019, 29(2): 447-453.
18. Cantivalli A, Rosso F, Bonasia DE, et al. High tibial osteotomy and anterior cruciate ligament reconstruction/revision. Clin Sports Med, 2019, 38(3): 417-433.
19. Dejour D, Saffarini M, Demey G, et al. Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture. Knee Surg Sports Traumatol Arthrosc, 2015, 23(10): 2846-2852.
20. 柳海峰, 陆伟, 梁达强, 等. 大腿肌群等速训练对前交叉韧带重建术后移植物塑形的影响. 中国修复重建外科杂志, 2019, 33(9): 1088-1094.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness comparison of LARS artificial ligament and autogenous hamstring tendon in one-stage reconstruction of anterior and posterior cruciate ligaments

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