THE LARS AUGMENTED 4-TUNNEL HAMSTRING 'HYBRID' ACLR GRAFT CONSTRUCTION ALLOWS ACCELERATED REHABILITATION WITHOUT KNEE LAXITY — CASE SERIES OF 111 PATIENTS AFTER 2 YEARS

摘要

Purpose: This prospective case series is designed to determine the 2-year clinical and radiological outcomes of patients undergoing an ACL reconstruction using the ligament augmentation reconstruction system (LARS) 133 prosthesis as an augmentation device for a 4-tunnel autologous hamstrings graft, in the context of accelerated rehabilitation. Methods: A total of 91 patients were assessed at 2 years post-operatively after undergoing an anterior cruciate ligament reconstruction (ACLR) with a doubled semitendinosis and LARS 133 prosthesis for the anteromedial bundle (AMB) and gracilis for the posterolateral bundle. Assessment included clinical review, KT-1000 arthrometry, IKDC, Tegner, Lysholm, Cincinnati and ACL QOL knee scoring, graft failure and re-operation rates. Tunnel positions and synovitis were assessed using gadolinium magnetic resonance imaging (MRI) scans and X-rays. Results: This technique in the context of accelerated rehabilitation is not associated with increased knee laxity and failure. There was no increase in knee laxity, with a mean side-to-side difference in KT-1000 arthrometer testing of 0.5 mm (+/— 1.7). Two-year outcomes were satisfactory with 98% of all patients having an IKDC rating of A or B, and mean values of IKDC subjective 86.5 (+/— 11.6), Tegner 6.5 (+/- 2.0), Lysholm 87.1 (+/- 8.9), Cincinnati 378.8 (+/- 41.5) and ACL Quality of Life 81.5 (+/--19.3). There was no evidence of synovitis and all tunnels were positioned satisfactorily. The graft failure rate was 1.1% and there was a re-operation rate of 15.4%. Conclusion: We conclude that LARS 133 augmentation of autologous hamstrings ACLR provides a graft construct allowing accelerated rehabilitation without increased knee laxity. It is not associated with significant synovitis within the first two years. Re-operation rates however are higher. The rates at which patients recover and return to life and sports activity following different ACLR graft types appears as a topic of future research interest.