Summary
Good results with low complication rates from using a synthetic graft in MCL and PLC reconstructions in 76 elite athletes.
Abstract
Background
The use and effectiveness of synthetic ligaments in medial collateral ligament (MCL) and posterolateral corner (PLC) reconstructions in the knee is underreported in the literature. Utilising synthetic grafts for ACL reconstruction represents a controversial topic. We wished to assess efficacy and safety in the scenario of extra-articular reconstructions.
Purpose
To assess the effect of an extra-articular knee ligament reconstruction utilising a LARS ligament on return to professional sport in elite athletes and to demonstrate the safety of LARS implants for extra-articular usage by reporting complications and sports career longevity.
Study Design
Case Series; Level of evidence 4
Methods
A retrospective review of a consecutive series of all extra-articular knee ligament reconstructions using LARS ligaments in elite athletes undertaken by 3 specialist sports knee surgeons between 2013 and 2020 was performed.
Patients were included if they were elite athletes aged 17 years or older and underwent an extra-articular knee ligament reconstruction utilising a LARS synthetic ligament, a minimum of 2 years previously. Patients were excluded if a LARS ligament was used for a PCL reconstruction. No LARS were used for ACL reconstructions. Return to play (RTP) was defined as competing at professional level or national/ international level in amateur sport.
Results
Sixty-four MCL and 12 PLC reconstructions utilising LARS in elite athletes were included. Fifty-two (68.4%) underwent concomitant cruciate ligament(s) reconstruction. The mean age was 25.1 years (SD +/- 4.5). Most were soccer (35, 46.1%) or rugby players (35, 46.1%).
Sixty-seven athletes (88.2%) RTP with 65 (97.0%) of these playing at the same or higher Tegner level. Fifty six (83.6%) of the athletes that RTP were still playing at 2 years post-surgery and 20 (57.1%) of those who had RTP and were more than 5 years post-surgery were still playing at 5 years.
Six (7.9%) players required further surgery relating to the LARS / metalwork. One case had an adverse local inflammatory reaction to the synthetic material and one MCL re-ruptured 4 years after RTP.
Conclusion
Utilising LARS in extra-articular knee ligament reconstructions allows 88.2% of athletes with a variety of knee ligament injuries to return to elite sport. The low morbidity rates coupled with 57% of athletes still playing 5 years post-surgery suggests the LARS is safe and effective in these cases.