Akrivos Vasileios S, Koutalos Antonios, Nastas Ioannis, Gkekas Nifon, Akritidis Pavlos, Gatos Evangelos, Hantes Michael
Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences University of Thessalia Larissa Greece.
J Exp Orthop. 2025 Aug 5;12(3):e70381. doi: 10.1002/jeo2.70381. eCollection 2025 Jul.
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).
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.
Twenty-five patients were included in the study. Clinical scores demonstrated significant improvement in Tegner activity scale ( = 0.0006), Lysholm Knee score ( = 0.0001) and IKDC score ( = 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.
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 IV.
评估韧带增强系统（LARS）前交叉韧带重建术（ACLR）失败后接受单阶段翻修手术患者的中期临床疗效和术中发现。
这项回顾性研究评估了使用LARS装置进行初次重建后接受ACL翻修手术的患者。临床评估包括Tegner活动量表、Lysholm膝关节评分和国际膝关节文献委员会（IKDC）评分，在术前和至少5年的随访时记录。术前进行影像学检查以评估隧道增宽、对线情况和关节炎改变的存在。术中评估包括关节镜检查滑膜、半月板和软骨。获取滑膜活检组织进行炎症组织学分析。
25例患者纳入研究。翻修手术后，Tegner活动量表（P = 0.0006）、Lysholm膝关节评分（P = 0.0001）和IKDC评分（P = 0.0001）均有显著改善，平均随访时间为7.8年（标准差 = 2.13）。术前影像学检查显示52%的患者有早期关节炎改变。术中发现所有患者均表现为滑膜炎症，滑膜炎发生率为100%。此外，根据国际软骨修复协会（ICRS）分类，68%的患者出现III期或IV期软骨损伤。
自体移植物单阶段翻修ACLR在LARS ACLR失败后带来了显著的临床改善，平均随访7.8年。翻修过程中的所有病例均表现为滑膜炎症，软骨损伤和早期关节炎的患病率较高。虽然这些发现可能表明合成移植物与退行性关节病变之间存在潜在关联，但无法确定因果关系，因为已知无论移植物类型如何，ACL重建失败后都会发生退行性改变。
IV级。
