Single-stage autograft revision for failed ligament advanced reinforcement system (LARS) anterior cruciate ligament reconstruction: Improved clinical outcomes at a minimum 5-year follow-up

Abstract

Purpose: To evaluate mid-term clinical outcomes and intraoperative findings in patients undergoing single-stage revision after failed ligament advanced reinforcement system (LARS) anterior cruciate ligament reconstruction (ACLR).

Methods: This retrospective study evaluated patients who underwent ACL revision surgery following initial reconstruction using the LARS device. Clinical assessments included the Tegner activity scale, Lysholm Knee score, and International Knee Documentation Committee (IKDC) scores, recorded preoperatively and at a minimum follow-up of 5 years. Preoperative imaging was conducted to assess tunnel widening, alignment, and the presence of arthritic changes. Intraoperative evaluations included arthroscopic inspection of the synovium, menisci, and cartilage. Synovial biopsies were obtained for histological analysis of inflammation.

Results: Twenty-five patients were included in the study. Clinical scores demonstrated significant improvement in Tegner activity scale (p = 0.0006), Lysholm Knee score (p = 0.0001) and IKDC score (p = 0.0001) following revision surgery, with a mean follow-up duration of 7.8 years (SD = 2.13). Preoperative imaging revealed early arthritic changes in 52% of patients. Intraoperative findings showed that all patients exhibited synovial membrane inflammation, with a 100% incidence of synovitis. Additionally, 68% of patients presented with Stage III or IV chondral lesions according to the ICRS classification.

Conclusions: Single-stage revision ACLR using autografts led to significant clinical improvement after LARS ACLR failure, with a mean follow-up of 7.8 years. All cases during revision demonstrated synovial inflammation, with a high prevalence of chondral lesions and early arthritis. While these findings may point to a potential association between synthetic grafts and degenerative joint pathology, causality cannot be established, as degenerative changes are known to occur following failed ACL reconstructions regardless of graft type.

Level of evidence: Level IV.

Keywords: ACL revision; anterior cruciate ligament reconstruction (ACLR); ligament advanced reinforcement system (LARS); synthetic grafts.

Figure 1

An anteroposterior (a) standing weight‐bearing radiograph and a lateral (b) radiograph of the left knee, obtained 6 years after ligament advanced reinforcement system (LARS) device implantation, revealed Grade III arthritic changes.

Figure 2

The patients are positioned supine, with the viewing perspective from the anterolateral portal on the right side. (a) Inflammated synovium in the medial wall of the suprapatellar pouch. (b) Inflammated synovium in the suprapatellar pouch and the presence of inflammated villi.