Title : LARS synthetic ligaments: A new frontier?
Abstract:
Introduction: The Ligament Augmentation and Reconstruction System (LARS) is designed to replicate the mechanical and anatomical properties of natural ligaments.The LARS synthetic ligament is made of 100% industrial strength polyester fibers. Each LARS contains a specific number and length of fibers, depending on their intended use. The active intra-articular portion of the LARS is made of longitudinal fibers, called “free fibers” without transversal fibers. The fibers are oriented according to the ligament they are made for, to mimic the anatomic fibers. This patented structure allows a high resistance to fatigue especially to flexion, torsion stresses and while observing a minimum residual elongation of the ligament. This porous and flexible structure allows colonization of the tissue. LARS in 5 points:
- Rapid return to sporting activities.
- Minimal invasive surgery, mainly by arthroscopy no long period of immobilization required.
- Full range of motion after 3 weeks no muscular atrophy.
- LARS is suitable for: The upper extremities: Rotator cuff tears, acromioclavicular, joint dislocation, distal biceps tears and others.
- The lower extremities: Anterior and posterior cruciate ligaments reconstruction ( intra articular), posteral lateral corner, quadriceps tears, patellar tendon tears and achilles tendon repairs (extra articular) and others. The LARS synthetic ligament can be used as an augmentation device in conjunction with autograft or allograft in acute or chronic injuries.
Objectives: This hybrid technique has revolutionized the use of synthetic ligaments in all types of reconstruction indications. The combination of biological and synthetic implants will create a homogenous fusion, thus creating a new hybrid approach. Combining biologic tissues and a synthetic implant to provide a fusion between both elements. A hybrid application will provide strength (early recovery with no elongation) and durability (extended life time).In acute (≥ 3 weeks) cases, the LARS ligament will work as an augmentation device combined with stump of the ACL. In chronic or revision cases, the LARS ligament is combined with a graft as an augmentation device intended for stress shielding.The postoperative care varies according to the technique used and the joint being repaired such as knee, shoulder, ankle. Generally, these indications apply: The LARS ligament enables you to start physiotherapy the next day after surgery so there will be no limitations, rapid full range of motion, less muscle atrophy, quicker return to sports and no brace is necessary.
Methods: Many publications through the years have demonstrated the use of LARS ligaments to have it's advantages versus conventional techniques. In a meta analysis study Jian Sun & all reserched in PubMed, Cochrane Library, and EMBASE for published Randomized Controlled Trials (RCT) and Case Controlled Trials (CCTs) to compare the outcomes of the autografts versus synthetics after cruciate ligament reconstruction. Nine studies were identified from the literature review. Of these studies, three studies compared the results of Bone–Patellar Tendon– Bone (BPTB) and ligament augmentation and reconstruction system (LARS), while six studies compared the results of Four-Strand Hamstring Tendon Graft (4SHG) and LARS.
Result & Discussion: The comparative study showed no difference in Lysholm score and failure risk between autografts and synthetics. The combined results of the meta-analysis indicated that there was a significantly lower rate of side-to-side in the synthetics group than in the autografts group. This systematic review comparing long-term outcomes after cruciate ligament reconstruction with either autograft or synthetics suggests no significant differences in failure risk. Autografts were inferior to synthetics with respect to restoring knee joint stability and patient-reported outcome scores, and were also associated with more postoperative complications. Conclusion: In conclusion, the combination of synthetic and biological ligaments, you benefit from the best of both worlds.
