Summary

Utilising LARS to augment extra-articular knee ligament reconstructions allows 88.2% of athletes with a variety of knee ligament injuries to return to elite sport.

Abstract

Introduction

There is no consensus on the optimal surgical management of medial collateral ligament (MCL) and posterolateral corner (PLC) injuries with evidence available for the use of autografts, allografts, and synthetic grafts. Although synthetic grafts have been linked to synovitis and tunnel osteolysis in cruciate ligament reconstruction there is little evidence available regarding their use for MCL or PLC reconstructions.

Aims

To determine if LARS ligament graft to augment extra-articular knee ligament reconstructions in elite athletes are safe and effective by reporting return to play rates and levels, career longevity, and complications.

Methods

A retrospective review of all extra-articular knee ligament reconstructions by 3 sports knee surgeons, utilising LARS, in elite athletes between 2013 and 2020. Athletes were aged over 16 years and a minimum of 2 years post-surgery. They were excluded if a LARS was used for a PCL reconstruction.
Return to play (RTP) was defined as first appearance at professional or national/ international level in amateur sport.

Results

There were 64 medial collateral ligament (MCL) and 12 posterolateral corner (PLC) reconstructions. 52 (68.4%) underwent concomitant autograft cruciate ligament(s) reconstruction. The mean age was 25.1 years (SD +/- 4.5). Most were football (35, 46.1%) or rugby players (35, 46.1%).
Sixty-seven athletes (88.2%) were known to return to elite sport, 7 (9.2%) did not RTP and RTP status was unknown for 2(2.6%). 65 (97.0%) of these returned to playing at the same or higher Tegner level. 56 (83.6%) of the athletes that RTP were still playing at 2 years post-surgery. 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 due to irritation from the metal fixation implants. One had an inflammatory reaction to the synthetic material at the proximal end of the LARS whereas the other cases all involved the tibial staples. All six cases were able to RTP.
One athlete, following bi-cruciate /MCL surgery had the LARS removed due to laxity and there was one MCL re-rupture when landing badly from a jump 4 years after returning to football.

Conclusion

Utilising LARS to augment 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 demonstrates that the LARS is safe and effective in these cases.