Vasileios S. Akrivos, Antonios Koutalos, Ioannis Nastas, Nifon Gkekas, Pavlos Akritidis, Evangelos Gatos, Michael Hantes
{"title":"单期自体移植翻修失败的韧带高级强化系统（LARS）前交叉韧带重建：在至少5年的随访中改善了临床结果","authors":"Vasileios S. Akrivos, Antonios Koutalos, Ioannis Nastas, Nifon Gkekas, Pavlos Akritidis, Evangelos Gatos, Michael Hantes","doi":"10.1002/jeo2.70381","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>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).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Twenty-five patients were included in the study. Clinical scores demonstrated significant improvement in Tegner activity scale (<i>p</i> = 0.0006), Lysholm Knee score (<i>p</i> = 0.0001) and IKDC score (<i>p</i> = 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.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Level of Evidence</h3>\n \n <p>Level IV.</p>\n </section>\n </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 3","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70381","citationCount":"0","resultStr":"{\"title\":\"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\",\"authors\":\"Vasileios S. Akrivos, Antonios Koutalos, Ioannis Nastas, Nifon Gkekas, Pavlos Akritidis, Evangelos Gatos, Michael Hantes\",\"doi\":\"10.1002/jeo2.70381\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Purpose</h3>\\n \\n <p>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).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Twenty-five patients were included in the study. Clinical scores demonstrated significant improvement in Tegner activity scale (<i>p</i> = 0.0006), Lysholm Knee score (<i>p</i> = 0.0001) and IKDC score (<i>p</i> = 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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Level of Evidence</h3>\\n \\n <p>Level IV.</p>\\n </section>\\n </div>\",\"PeriodicalId\":36909,\"journal\":{\"name\":\"Journal of Experimental Orthopaedics\",\"volume\":\"12 3\",\"pages\":\"\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2025-08-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70381\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Experimental Orthopaedics\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://esskajournals.onlinelibrary.wiley.com/doi/10.1002/jeo2.70381\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Experimental Orthopaedics","FirstCategoryId":"1085","ListUrlMain":"https://esskajournals.onlinelibrary.wiley.com/doi/10.1002/jeo2.70381","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
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
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.
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