Ttreatment of knee multiple ligament injury with LARS artificial ligament Dai Guofeng, Wang Cheng Department of orthopedics, Qilu Hospital of Shandong

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1 LARS 人工韧带重建 PCL 的手术体会与病例随访温鹏, 马军中国宁夏回族自治区人民医院 [ 背景 ] 人工韧带作为重建 PCL 的移植物能够避免自体异体肌腱的缺点, 而且供源可靠韧带强度高, 有着广阔的发展空间 LARS 人工韧带作为韧带增强重建系统自 1995 年投放市场至今已有 20 年, 从现有国内外文献报道结果来看, 临床效果良好然而, 受美国早期人工韧带失败病例影响, 目前国际上有相当多医生对人工韧带持怀疑与负面态度, 所有有必要对 LARS 人工韧带重建 PCL 的临床效果进行深入的随访研究中国宁夏回族自治区人民医院 2005 年开展首例关节镜下 LARS 人工韧带 - 后交叉韧带重建术, 至今已完成 60 余例手术本研究的目的就是探讨使用 LARS 人工韧带关节镜下重建 PCL 的手术体会与临床效果 [ 材料与方法 ]1. 对 2005 年至 2015 年我院使用 LARS 人工韧带重建 PCL 的患者进行随访, 通过了解患者术后的情况包括疼痛肿胀交锁稳定性及活动度以及使用 Tegner 膝关节运动评分标准对患者术前术后的运动情况进行评分, 来评价临床效果 2. 总结关节镜下单纯前侧入路, 使用 LARS 人工韧带重建 PCL 的手术经验和体会 [ 结果 ] 总共纳入了 60 例患者, 其中成功随访 51 例失访 9 例 1 例病人术后 6 年出现韧带松弛并创伤性关节炎, 行 TKA 手术 2 例患者在术后 3 年出现韧带松弛, 但无疼痛症状无滑膜炎患者所有患者 Tegner 评分术后均较术前明显改善 [ 讨论 ] 1. 为什么我们使用 LARS 韧带愈来越多的是重建 PCL? 首先,PCL 损伤多合并多发韧带损伤, 应用人工韧带可以保证移植物的供应其次, 应用人工韧带重建 PCL 定位更准确, 从骨隧道穿过更容易, 不需要后侧辅助切口手术简便创伤更小 2. LARS 韧带重建 PCL 的注意事项首先, 韧带残端尽量不要切除, 以保留韧带上的机械刺激感受器, 还可提供腱细胞和滑膜细胞包裹人工韧带完成重构其次, 不能使用可吸收材料固定最后, 采用钛合金螺钉固定必须在皮质骨水平挤压固定, 即螺钉尾端恰好平皮质骨才能达到最佳固定效果 [ 结论 ]1. 关节镜下应用 LARS 人工韧带重建 PCL 手术更简便创伤更小 2. LARS 人工韧带重建 PCL 术后随访临床效果良好

2 Ttreatment of knee multiple ligament injury with LARS artificial ligament Dai Guofeng, Wang Cheng Department of orthopedics, Qilu Hospital of Shandong University No. 107 of Cultural West Road, Ji'nan City Shandong Province, PRC Post code:250012; Objective: To discuss the role of LARS artificial ligament in the reconstruction of knee with multiple ligament injury. Methods and materials: LARS artificial ligament was used in treatment of knee multiple ligament injury in 35 cases,including 29 males and 6 females with age from 17 to 45 years. There were 32 cases of acute or subacute injury, 3 cases of delayed injury, involving ACL+PCL rupture in 15 cases, ACL+PCL+PLC 10 cases of ACL+PCL+PMC rupture in 3 cases, ACL+PCL+PMC + PLC injury in 2 cases. Generally LARS was used for PCL reconstruction, hamstring autograft for ACL reconstruction. PLC was repaired with suture, anchor, or using a PLYY100 bundle for reconstruction; PMC was repaired with suture or anchor. Results: immediate stability was achieved after operation in all cases, with confirmation of anterior and posterior drawer test (-). The postoperative follow-up ranged from 8 months to 5 years. At the latest examination, despite of 1 case of delayed dislocation was observed posterior drawer test (+), all the remained 31 cases were of satisfactory stablility. No complications such as intraarticular infection, synovitis occurred. The average postoperative Lysholm score at latest examination was significantly higher than preoperative status(86.5±3.5,48.6±4.6,p < 0.01). Conclusion: LARS could effectively resolve the challenge of insufficiency of autologous reconstruction materials, when dealing with multiple ligament injury of knee. Besides of reducing additional injury or complications concomitant with autologous tissue harvesting, LARS excels at immediate stability,early mobilization and rapid recovery. According to our experience, multiple ligament injuries of knee should be actively reconstructed as early as possible. LARS artificial ligament is a satisfactory option for treatment of knee multiple ligament injury.

3 Cruciate ligament reconstruction with LARS artificial ligament results at a mean follow-up of ten years 应用 LARS 行膝关节交叉韧带重建术后平均 10 年的临床随访研究 Xuan Huang, Zimin Wang, Weidong Xu, Department of Orthopeadics, Changhai hospital, Shanghai, China Background: There are many different materials used for ligament reconstruction. Currently, autograft, allograft, and artificial ligaments are used in the reconstruction. The objective of this study was to explore the long-term clinical result of cruciate ligament reconstruction under arthroscopy in a single institute. Methods: Eighty-one cases were reconstructed with the LARS ligament under arthroscopy, including 43 cases of anterior cruciate ligament (ACL) injury, 20 cases of posterior cruciate ligament (PCL) injury, and 18 cases of ACL combined with PCL injuries of the knee. The follow up period was 106 to 134 months. The International Knee Documentation Committee (IKDC) and Lysholm knee score scales were used for functional evaluation. We examined the anterior and posterior stability of the knee with KT Results: According to the Lysholm knee function score scale, the average preoperative score of (44.6±1.4) increased to a postoperative score of (82.8±2.5) in the ACL group and from (46.6±2.3) to (80.8±2.0) in the PCL group. In the ACL combined with PCL injury group, the preoperative score increased from (45.2±1.2) to (85.5±2.3). According to IKDC score standards, in ACL group we evaluated 19 cases as C and 24 cases as D, preoperatively, and postoperatively 27 cases as A, 14 cases as B and two cases as C. In the preoperative PCL group, we had 11 cases defined as C and nine cases as D that resolved to 12 cases as A, seven as B and one case of C in postoperative evaluation. In the ACL combined with PCL injury group we defined four cases as C and 14 as D during preoperative scoring. These patients had postoperative grades of six cases as A, 10 as B, and two cases as C. All of the results have statistical significance. Conclusion: ACL, PCL, or combined ACL and PCL reconstruction using the LARS ligament under arthroscopy is a minimally invasive, safe and effective method to treat cruciate ligament injuries of the knee. Clinical results are satisfactory in the long term follow-up. Key words: anterior cruciate ligament reconstruction; posterior cruciate ligament reconstruction; ligament advanced reinforcement system

4 LARs 韧带重建 PCL 术后的翻修及疗效分析李卫平宋斌杨睿陈仲谭伟权中山大学孙逸仙纪念医院运动医学科, 广东省广州市摘要目的 : 探讨 LARS 韧带重建 PCL 后翻修的手术方法及疗效分析方法 : 自 2011 年 1 月至 2014 年 1 月共收治 11 例 LARs 韧带初次重建膝关节 PCL 再断裂患者, 对 7 例自体和同种异体肌腱作为移植物, 4 例患者应用同种异体肌腱, 股骨端采用 Endo-button 和界面螺钉固定方法, 胫骨端采用界面螺钉固定,6 例患者术中可见人工韧带周围大量滑膜组织增生, 人工韧带未见明显滑膜化, 韧带松弛明显,7 例患者胫骨端骨道位置过高,3 例患者双侧骨道位置均异常, 所有患者骨道内韧带与骨组织未见明显愈合, 先对关节内韧带组织进行彻底清理后再进行重建以 Lysholm Larson IKDC 评分评价临床疗效结果 :11 例患者中男性 9 例, 女性 2 例, 年龄 :23-30 岁 ( 平均 :26 岁 ),11 例均获得随访, 随访时间 1~4.5 年, 平均 2.5 年所有患者均未再次出现再断裂, 关节活动度正常, 后抽屉实验弱阳性 2 例,Lachman 征弱阳性 1 例 ;Lysholm Larson IKDC 评分分别由术前 (58.3±3.75, 61.1±2.88,60.25±2.28) 分提高到 (88.6±2.78,86.25±3.01,89.55±2.71) 分, 差别有统计学意义结论 Lars 韧带重建 PCL 后失败的原因, 以骨道位置异常以及腱骨愈合不良为主要原因, 根据患者肌腱情况采用自体和 ( 或 ) 同种异体肌腱, 可获得较为满意的临床效果, 远期效果需要进一步观察 [ 关键词 ] 膝关节 ; 后交叉韧带 ; 关节镜 ;LARS 韧带

5 The Osteoarthritis and Activity Level at a Mean of Nine Years after the LARS-ACL Reconstruction Tianwu Chen 1,2 ; Shiyi Chen 1,2 1. Department of Orthopedic Sports Medicine, Huashan Hospital, Shanghai, China 2. Sports Medicine Center, Fudan University, China Background: In literature, the degenerative change was a common condition following the anterior cruciate ligament (ACL) reconstruction 1-3. While return to sports, especially for contact athletics, was never an easy task for a patient undergone such procedure 4,5. The LARS artificial ligament was proved a good graft choice in the ACL reconstruction from short- and mid-term follow-up researches 6,7. Whilst for the long-term outcomes, it is still misty and controversial due to limited reports of inconsistent outcomes. The objective of this study was to evaluate the occurrence of osteoarthritis (OA) in the ACL reconstruction with the LARS artificial ligaments and to assess which activity level the patients could retain at a mean of nine years postoperative. Materials: Thirty-four patients of the ACL injury accepted the arthroscopic ACL reconstruction using the Ligament augmentation reinforcement system (LARS) between July 2004 and July Methods: The evaluation included patients-reported questionnaires (Tegner Activity Score, IKDC Subjective Knee Evaluation Form, and Lysholm Score), objective evaluation (physical exam and instrumental measurement), as well as radiographic exam (X-ray). The objective exam was assessed according to the 2000 IKDC Knee Evaluation Form. Regarding the radiographic exam, we measured the degenerative condition according to the Kellgren & Lawerence (K & L) classification. The cases of radiographic OA (K&L grade 2) demonstrating symptoms within one months were defined as symptomatic OA condition. Results: With 5 unavailable cases, 2 failed cases, and 4 cases only having subjective results, full investigation was finally fulfilled in 23 cases at a mean time of 108 months postoperative. In radiographic exam, the medial compartment was mostly affected and the overall outcome was that 5 cases were classified as grade 0; 10 cases were classified as grade I; 6 cases were classified as grade II; and 2 cases were classified as grade III, no cases was of grade IV. Since the OA condition was defined as grade II according to the K&L classification, the rate was 34.8%. Among them, symptomatic OA was only observed in 2 cases. The mean Tegner activity score was 6.4 ± 0.9 (5 to 9). Furthermore, 17 cases still maintained their pre-injury sports events, while 10 cases either chose another game events or avoided contact athletics due to the memory of some specific injury mechanism or certain social and professional factors. Notably, the patients of combined meniscus injury demonstrated inferior activity level and subjective evaluation. Discussion:

6 The degenerative change was a common condition following the ACL reconstruction. In literature, it had been proved that the ACL reconstruction with traditional grafts could not prevent the OA occurrence. Regarding the ACL reconstruction, the LARS was proved a satisfactory device compared with early artificial ligaments in short- and mid-term follow-ups. However, so far the long-term investigation of the ACL reconstruction with such device was scant and the outcomes obtained from limited reports were inconsistent. In this study, we found that the long-term outcome of the LARS-ACL reconstruction was satisfactory and most patients maintained good activity level. The postoperative degenerative change did exist but the rate of OA was comparatively lower than that of surgery using auto/allografts 8,9. Return to sports was not always satisfactory in the ACL reconstruction, especially for patients using autografts. The patients of the LARS-ACL reconstruction retained good activity level, and we supposed that fast recovery and no harvest morbidity might contribute to this outcome. Conclusion: The LARS-ACL reconstruction did not prevent the common occurrence of osteoarthritis in knee joint long-term postoperative, while the sports activity was satisfactory compared with traditional methods using auto/allografts. References: 1. van der Hart CPvan den Bekerom MP, Patt TW. The occurrence of osteoarthritis at a minimum of ten years after reconstruction of the anterior cruciate ligament. Journal of Orthopaedic Surgery and Research 2008;3-1: Salmon LJ, Russell VJ, Refshauge K, Kader D, Connolly C, Linklater J, Pinczewski LA. Long-term outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft: minimum 13-year review. Am J Sports Med 2006;34-5: Hui C, Salmon LJ, Kok A, Maeno S, Linklater J, Pinczewski LA. Fifteen-Year Outcome of Endoscopic Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft for "Isolated" Anterior Cruciate Ligament Tear. The American Journal of Sports Medicine 2011;39-1: Ardern CL, Webster KE, Taylor NF, Feller JA. Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by 12 months after surgery. Am J Sports Med 2011;39-3: Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med 2011;45-7: Pan X, Wen H, Wang L, Ge T. Bone-patellar tendon-bone autograft versus LARS artificial ligament for anterior cruciate ligament reconstruction. Eur J Orthop Surg Traumatol 2013;23-7: Gao K, Chen S, Wang L, Zhang W, Kang Y, Dong Q, Zhou H, Li L. Anterior Cruciate Ligament Reconstruction With LARS Artificial Ligament: A Multicenter Study With 3- to 5-Year Follow-up. Arthroscopy: The Journal of Arthroscopic & Related Surgery 2010;26-4: Barenius B, Ponzer S, Shalabi A, Bujak R, Norlen L, Eriksson K. Increased risk of osteoarthritis after anterior cruciate ligament reconstruction: a 14-year follow-up study of a randomized controlled trial. Am J Sports Med 2014;42-5:

7 9. Oiestad BE, Holm I, Aune AK, Gunderson R, Myklebust G, Engebretsen L, Fosdahl MA, Risberg MA. Knee Function and Prevalence of Knee Osteoarthritis After Anterior Cruciate Ligament Reconstruction: A Prospective Study With 10 to 15 Years of Follow-up. The American Journal of Sports Medicine 2010;38-11:

8 Carbon Nanotube: A New Potential Ideal Material of Synthetic Ligament (Tendon) Graft Fang Wan 1, Jia Jiang 1, Peining Chen 2, Fang Chai 1, Huisheng Peng 2 Shiyi Chen 1 1 Fudan University Sports Medicine Center & Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, Shanghai , People s Republic of China 2 Department of Macromolecular Science and Laboratory of Advanced Materials, Shanghai , People s Republic of China The author does NOT agree to transfer all copyright ownership in and relating to the abstract, in all forms and media, to 2016 Congress of APKASS & 13th IFOSMA. Thus, the abstract is NOT published.

9 Arthroscopic reconstruction of medial patellofemoral ligament with LARS artificial ligment for the treatment of recurrent dislocation of the patella Wei Huang 1, Ning Hu 1, Hao Chen 2 1: Department of Orthopedics, the First Affiliated Hospital, Chongqing Medical University, Chongqing, , China 2: Department of Orthopedics, Yubei District People s Hospital, Chongqing, , China Objective: To investigate the clinic effect of the arthroscopic reconstruction of medial patellofemoral ligament(mpfl) with LARS artificial ligament in recurrent dislocation of patella(rdp). Methods: Twenty-six cases of RDP were treated by arthroscopic reconstruction of MPFL with LARS artificial ligament from Mar to Sept Ten were bilateral. Preoperative plain X-ray, CT and MRI understand the condition of patellofemoral joint and MPFL. The arthroscopic examination was undertaken before the reconstruction to observe the dynamic patellofemoral congruence and the patella track, as well as articular cartilage. The MPFL was reconstructed with LARS artificial ligament. The arthroscopic examination was do to understand the restoring dynamic patellofemoral congruence and the patella track after the reconstruction. The patients trained function postoperatively. We evaluated the knees with Install standard postoperatively. Results: No cases occurred infection, LARS artificial ligament didn t rejection reaction and rupture postoperatively. The patients were followed up for 6 and 24 months. The average was 13 months. All cases function were evaluated with Install standard postoperatively. Twenty-two cases were excellent, Four cases were good. Patella reduction was excellent with X-ray. There was no recurrence of dislocation or sublocation. Conclusion: It is effective to treat RDP by the way of reconstruction of MPFL with LARS artificial ligament with arthroscope.

13:30--14:00 14:00--14:30 14:30--15:00 15:00--15:10 15:10--15:40 15:40--16:00 16:00--16:30 16:30--17:00 17:00--17:30 17:30--17:40 Luncheon Symposium S

13:30--14:00 14:00--14:30 14:30--15:00 15:00--15:10 15:10--15:40 15:40--16:00 16:00--16:30 16:30--17:00 17:00--17:30 17:30--17:40 Luncheon Symposium S 2014 年中国关节镜膝关节外科和骨科运动医学大会暨第十五届全国关节镜技术与新进展学习班 2014 China Arthroscopy, Knee Surgery and Sports Medicine Conference Agenda / 日程会议地点 /Venue: 北京金隅喜来登酒店 / Sheraton