ACL Reconstruction - LARS Ligament

[jamiec123]

Hi people,

Found this forum and though i'd share my story with you guys and hopefully get some sort of feedback.

I'll set the scene:

First game of the football season, early september, game is 5 minutes in, i pick the ball up on the half way, beat their centre midfielder and head straight towards goal, as i jink inside of their centre back, i plant my right leg and he smashes into the side of my knee.  My studs are fully in the ground, i hear a giant "CRACK" and i collapse under my own weight, i then head another "CRACK" as i hit the floor.  I had dislocated my kneecap and torn my ACL in half.

Since then i had problems with full extension due to my ACL stump getting caught in my joint and have since had it trimmed to stop this from happening.

My next step is to have a full ACL reconstruction (in 3 weeks time) and ive opted for the LARS ligament.  Apparently they are not very common at the moment in the UK and are more commonly used in France and the US.  For those of you who havent heard of a LARS ligament, here's a link www.larsligament.com/

My questions for you guys are:

1) Has anyone else had the LARS in their knee?  What were your results? could you go back to sport, in particular football?
2) Anyone have any advice, other than the obvious, do as your surgeon says, exercise it, ice it etc etc
3) At my physio i use a cryo cuff for icing which i love, do you think its worth me buying one? some people say yes and others say no a bag of peas will work lol.

Any feedback would be greatly appreciated,

Thanks guys,

Jay.

[Kaputt_Knee]

If you do a search on LARS here you will find a number of threads about them - it is fairly controversial one way or another. A bit like Marmite - love it or hate it.

I used to be strongly against, having had two earlier artificial fibre ligaments in my right knee. I was lucky in a way, although I did not think so at the time. Others, whose artificial fibre ligaments did last for longer had them degenerate in their knees. some poisoned the system so much they ended up with amputations. That is why the FDA and other regulatory bodies are not so quick to approve them I presume. However some interesting and very positive personal stories have opened my mind to the possibility that these may be a vast improvement on what went on earlier.

LARS is used in the UK, but not often as a primary graft. It is not well thought of here in Germany/Austria where they do thousands of reconstructions each ski season. Why they are so prejudiced, I'm not sure.

Work on getting as much ROM and strength as you can going into the operation as good condition and ROM are usually good precursors to a successful rehab.

Please keep us posted as I believe that more positive stories and long term reports will help to remove the prejudice that built up as a result of the bad experiences with artificial fibres in the past.

 

[clarky_vl]

Hi,
May I ask what made you decide to go with a LARS, especially as this is your first reconstruction (as I read it)? Also, will the LARS be used alongside a tendon graft?

As Sue said, do a search on here to find relevant discussions on the use of LARS. There are some useful threads that you might find helpful.

Vicky

[jamiec123]

Thanks for your comments guys!

I am going with LARS as my surgeon recommended it and also if they go with hamstring or bone-patella-bone and that fails, i have not only got no ACL but other weaknesses in my leg too.

If LARS fails then at least the rest of my leg will be ok!

According to my surgeon, they have made huge improvements to the LARS ligaments now and he often suggests that option for suitable people.

Jamie

[tony1233]

Since then i had problems with full extension due to my ACL stump getting caught in my joint and have since had it trimmed to stop this from happening.

jamiec123,

I am experiencing similar problems getting full extension since my ACL injury. I am wondering if this is what is happening to me ? Was it painful when you tried to fully extend ? I can get it slightly futher now then at first but, when I try to extend fully my leg begins to shake and hurt incredibly. Also did you get a cracking sensation when you bent your knee ? I am experiencing that and I'm hoping that it is from my ACL injury not a meniscus injury. None showed up on my MRI however, the PT thinks I do have a meniscus injury.

[clarky_vl]

Hi,
I have had two LARS grafts, but they were different from what I think you are having as they were alongside normal tendon grafts (hamstring then quadriceps) and were for revisions. I found the recoveries to be similar to the original non-LARS graft, but then I suppose what I had basically was a normal reconstruction but with LARS aswell.

There is a thread on the general knee section about LARS that might interest/help you (started by kneedad), as it is the story of someone who had a LARS graft that was successful and gives a realistic account of the kind of recovery you can expect.

Please keep us updated with how you get along with this graft so there is more information available for those considering it!

Good luck!

Vicky

[jamiec123]

Tony1233 - After i had my ACL trimmed, my knee went back to full extension and even back to the hyper extension levels i had beforehand!!

Clarky_vl - I wasnt aware of the option of combining the LARS ligament with normal tendon grafts, sounds very interesting!  Regarding people know how i get on, of course i will, hopefully the info i give can assist people in their recons etc!

Cosmicsnuffle - Thanks for your private message, for some reason i cant reply, anyone know why?!?!?!  I cant seem to private message anyone!  If i cant get it to work i will post a reply on this thread for you!

Any more questions or advice always warmly received!

Jamie.

[Kaputt_Knee]

You cannot reply because you do not have 20 posts on the open forums. It is a safety mechanism to stop spammers from joining the site and firing off spam or worse. Have patience and you will get the rights to send PMs after your 19th post.

I for one would prefer to see an OPEN discussion about this development. There is a lot of misinformation on sites like this, although passed on with the best intentions for the most part. There are also, unfortunately, people who have their own agenda for whatever reason for promoting or dismissing one particular treatment or another.

The more open and personal experience discussion there is about this particular graft choice, as well as how it is used to augment autografts, the better informed the community will be. We have several people who have personal and relevant experience of these grafts - Vicky's is, as far as I know, the only member here who has had TWO unsuccessful implants. We have also had two marketeers here making wild fantastical claims which bear no relationship to reality.

I am a lucky survivor of the earlier artificial  grafts, a while back there was a lady here whose carbon fibre graft had disintegrated in her knee and she had had to have many operations to remove the fibres which were poisoning her system. And was going for a new knee while still relatively young.

Something I have learnt here is that there is no quick fix, nor is there one standard operation or rehab. This backs up my own personal experience. Each and every single one of us has different issues which affect the operation we undergo and how the successful or not the rehab goes. Some people come here get advice, ask questions have their op and go, never coming back. Some never post anything, but read a lot and benefit from the unique store of information here.

Others, sadly, come here, read a bit then think they are experts and fire off answers all over the place promoting one particular "cure" or another. As "Knee Geeks" - just a number by the way, not a medical degree; they feel qualified to offer advice and diagnosis over the internet and their opinion is as valuable as the practitioners treating the problem in person. This is the nature of internet forums, unfortunately desperate and gullible people seeking information to help them cannot always see the differences until it is too late.

Please can we keep the discussions with regards to this option open and public. Anyone with personal experience of this or any other artificial ligament is in a position to share that experience and their take on their recovery for others to read and maybe learn from. As for the marketeers, they are seen coming a mile away and usually seen off. I would love to read some comments from doctors who have used this technique or therapists who have treated people post-operatively. However, this is the internet and we have to take anyone's declaration of professional experience with a pinch of salt. We have no way other than common sense of deciding who is for real and who is a fantasist. 
[/rant)
OK rant mode off!

I've looked at the web site you linked to Jamie and found some interesting reading, but it is mostly sales talk for patients sadly. It actually is linked to the rather naive sales site of a certain Ms Becky Thomas, aka Norcalgirl, who was on here about 3 years ago making some wild and grossly misrepresentative statements.

The LARS option is one of many options and I would be asking my surgeon exactly why they favour it and hope to hear some informed opinion based on personal experience, not a regurgitation of the web sales pitch! It is a real hot potato in the orthopaedic world, a bit of a Marmite subject - love it or hate it, no in between! 

Sue 

[Cosmicsnuffle]

Hi Jamie,

... no worries about the pm - it was me being a numpty an not checking your number of posts! ... and thanks, you've answered my question in your last post :-)

Kaputt-Knee - I have read some of your other posts about LARS and understand that it is controversial subject for you, as is the sanctity of the KG forum, and rightly so.  FYI the pm I sent to jamiec123 was a specific communication regarding my own situation which was nothing to do with LARS, and was therefore not relevant to this thread....
I felt obliged to let you know as I felt that your 'rant' was unduly aimed in my direction (please correct me if I'm wrong!) - apologies for pushing your button if it was me!

Cos

[jamiec123]

With all respect Kaputt-Knee, i started this thread to get people's advice and opinions.  I dont think the rant about LARS was justified.  Just because i have chosen to have it and it is being discussed.

[Kaputt_Knee]

It was not a rant against LARS or anyone in particular. Perhaps the ironic use of the "rant mode" was too subtle for some   

If anything it was a rant against closed minds on any one side or another. There are lots of sources of information available and people should use them appropriately. We should have open and mutually respectful discussion, but unfortunately the nature of boards such as these is that sometimes things go off at a tangent and descend into silly fights.

Due to my own experience of artificial fibre ligaments, I was very much against their use, even though I was one of the luckier ones. Reading more and more about LARS,  I have modified my views to neutral. I am neither pro nor contra. I followed Kneedad's posts with interest as this was a new and interesting development, and he presented his arguments clearly factually and without any marketing. We corresponded outside of this board and I have nothing but admiration for his choices and the achievements of his son as a result of the use of this material. but it was far from the quick fix many people would have you believe it is.

The site you linked to here Jamie is the marketing aspect of one of the franchises. If you Google LARS you will find a variety of sites where this material is presented in a more scientific and factual way. They have better links to studies that you can read and evaluate. They make interesting reading even for the layman. The Corin sites are particularly good. Your site and that of Ms Thomas are produced by the same people, indicating they are part of the same franchise. BTW if you look at the thread on this site started by Ms Thomas, she has deleted ALL her responses to the questions set by the opposition as they did not stand up to scrutiny. The thread is somewhat bizarre as a result but still turns up quite highly placed in a Google search on the subject.

I work in the area of R&D in medical devices and know the procedures for gaining FDA or any other regulatory body's approval for use. It is extremely detailed and very strict as the cost of getting wrong is too high in terms of patient suffering as well as in the fiscal sense. My job involves translating and editing all the documentation for presentation to the regulatory bodies so I personally know the mountains of work that go into this process. I am working in this area purely by chance as I had to give up my job as a sports specialist due to the problems with my knees. Some of these problems were caused by the use of artificial fibre ligaments in the 1980s and 1990s.

LARS means that the ligament reconstructions are augmented with the fibres (LIGAMENT AUGMENTATION & RECONSTRUCTION SYSTEM) .

My suggestions were to ask your surgeon why he believed that this is the way to go. What is he basing his decision on, that sort of thing. It is much more commonly used in the augmented role than people realise. We have at least two documented post-op diaries here where it was used - one successfully and the other sadly not. If he just gives you the sales talk back, then maybe it is worth getting a second opinion. If you feel he has given you a reasoned rational and you are confident in his expertise, then go with it.

I offered you some ideas and suggestions. I have neither preached for nor against it.

May I respectfully suggest that you read my posts again before accusing me of something that I was not engaged in! 

[jamiec123]

In that case i apologise, i think i may have misinterpreted your post.  I hope you will accept my apology?

Perhaps i should explain my choice for LARS a little more?

The reason my surgeon and I came to the decision to use LARS was for a number of reasons.  1) The fact that my hamstring tendons may be too short to use (im only 5'6), 2) not wanting the bone patella bone option due to not wanting a full slice across my knee and 3) the new advancements in the LARS ligaments since their invention.  My surgeon believes that the stump of my ACL is in a decent enough condition and still long enough to pass the LARS ligament through the middle and act as a "trellis" for the ruptured ACL to hopefully grow back up.

I guess only time will tell if this is the correct option!

My surgeon himself isnt necessarily "Pro LARS", he does more Hamstring and Bone Patella Bone ops than LARS, it just seemed like the better option to try the LARS technology.

Personally I dont believe his advice is a sales pitch and he has all the necessary credentials i.e. Member of British Association For Surgery Of The Knee, Member of British Society of Orthopaedic Foot Surgery, Member of British Orthopaedic Association, Fellow of Royal College of Surgeons, Examiner of Royal College Of Surgeons Edinburgh and has treated many people with both major and minor ACL injuries, including elite sportsmen and women.

I have just over 2 weeks until i go under the knife, im very very excited in a strange kind of way!

Jay.

[Kaputt_Knee]

Thanks for that - apology accepted!

I'm only 5' 3" and they have harvested twice from the same hamstring, but I do have long hamstrings and am very flexible!  As both my knees have had patella grafts taken from them I understand why you are reluctant to go down that path! Haven't been able to kneel since! Not that I'm praying much these days 

The fact that you have good basic stumps is one of the indicators of a good outcome with LARS as far as I have read. Sounds like a pretty good call and definitely worth a try.

Do you know what your surgeon is proposing as a post-op rehab protocol? Some start with rehab within 48 hours, others wait a bit. It will be interesting to read what you have to do. Will you be staying in hospital or is it day surgery?

Maybe Vicky (clarky_vl) will be able to exchange experiences with you. Her LARS augmentations failed but she does not know why - maybe the LARS, maybe something else.

I will be off skiing when you have your op, but will have my laptop with me so I will try and remember to look in. If you post your post-op thread on this board, I'm pretty sure you will get lots of help and comments as there are loads of us here still active who have "been there, seen it and worn out the T-shirt" 

Sue 

[Cosmicsnuffle]

"Rant mode" is cool, and something I am personally not adverse to using - either that or the soap box (but it's more like a crate more recently  )

Text conversations by their nature are prone to misinterpretation - Kaputt_Knee  I wanted to make sure that I hadn't offended you - so if I haven't that's cool too.

Jamie - I've been to see a private specialist today - a glorious 50 minutes of knee discussion compared to 4 minutes in the last 6 months to date!  He believes that arthrofibrosis is causing my knee to remain locked post ACL stump debridement, and that he would not recommend reconstruction until I have full extension. Guess who gets another scope   before ACLr..... but do you know... like you I'm actually getting excited about the possibility of being fixed!

Happy countdown :-)

[jamiec123]

Ha ha ha 50 minutes must have seemed like your birthday and xmas all rolled into one!!

Arthrofibrosis, isnt that scare tissue related??  Talking about scar tissue, i still get a bit of pain out of my scars, especially the one above my knee.  And its still quite "lumpy" whereas the 2 cuts under my knee have really gone down nicely!  Ive taken to rubbing bio oil into them lately, but im not sue how else to break down the scar tissue and make it less painful!

I've just ordered myself a cryo cuff   i know its not necessarily needed but it saves me getting up all the time to change my ice pack post reconstruction!

Its a bit morbid really, looking forward to being operated on!  So how did you do your knee Cosmic?

Jamie.