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Offline cassieoz

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Re: LARS question
« Reply #15 on: September 11, 2008, 11:51:46 PM »
Hi kneedad,

Im sorry to read this and know its a hard decision. I feel for you and your family!!

I have read every post and tend to agree with the athletes, not because im against LARS.

I think 9 months is good time to get a young athlete into sport. If he has good strength before he goes in then he will definately get it back. Muscles have a memory, i had good muscle strength back at 6 months and i had my surgery done the same time as a rugby player and he was back playing professionally at 8 months no problems at all. We were both ambitious. I think you will be surprised on how well his rehab will go, i was!

Im not too sure about the 6 hours a day rehab either......please look into that!

Good luck let us know what happens please on what ever decision you make, we do not judge on knee guru.

Cassie x
LEFT KNEE
1st ACLr -Hamstring 17th August 2007
2nd ACLr -Allograft hamstring 5th September 2008
Bone Allograft- 24th November 2014
3rd ACLr - Patella 22nd June 2015

Offline Silkncardcrafts

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Re: LARS question
« Reply #16 on: September 12, 2008, 10:42:29 AM »
Hi there,

Today there was quite a comprehensive article in a Melbourne newspaper (Australia) about the LARS technique for elite athletes. Basically the consensus for elite athletes is there hasn't been enough success with this operation whereas the gold standard method has a much higher success rate.

Doing 6 hours of rehab really isn't neccessary. Even elite athletes in Australia don't do that much. I work as a sports trainer and have never heard that happening. Just some food for thought.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline kneedad

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Re: LARS question
« Reply #17 on: September 27, 2008, 04:27:13 PM »
Hi.

I have decided to come back to this site to share our experience with all of you. If you are interest we will continue to do so. It was mentioned in a post that KneeGeeks dont judge, so If this is the case we would be more than happy to keep every one up dated. If we end up getting slammed for doing something that you just dont agree with, then we wont bother.

By now I am sure you all have figured out that we have chosen to go with the Lars.
What I want to share with you is what really happpens and the true recovery etc. Not a commercial for Lars.

We had the surgery done in Montreal on Sept 8th.

It took about two and half hours. We had it done with a spinal.
At the same time the miniscus was repaired (stitch)

we had the choice to stay in over night or go back to the hotel, we chose to stay in the clinic for a night, which I am glad we did as the spinal wore off, the pain was qite intense.

In the morning he was sitting in a chair eating breakfast before we left.

the trip home was not much fun as they wanted him up and around every hour to reduce chances of clots I assume. getting in and out of the car was not much fun. I also made the mistake of trying to reduce his pain meds on the trip as my uneducated fear of addiction (wrong wrong wrong) take the meds and be comfortable. got home about 7 hours later and into be with Ice and elevation.

He seemed to like the attention of being served in bed and with the meds in check seemed quite comfortable. Swelling was not to bad, and I changed the dressing daily. Spoke to our therapist on Thursday who said that laying around was wrong and he should be up and around by now, and was concerned that he wasnt. We had a little chat and I explained to him that this is going to be hard and painful at first but he needed to get going. By the end of the day thursday we was moving around the house on his crutches. Lots of ice and elevation seemed to do the trick.

Friday was the first day at therapy as she just wanted to see him ( she is not a Lars fan, or should I say does not know about it) she check his stitches, all okay. she seemed a bit puzzled as the out side stitch on his thigh was higher than she had every seen in any other surgery? she gave him some exercises and we were on our way.

By Monday he was back to school on crutches.

Post op instructions from the surgeon was, no weight for 2 weeks and not past 90 for 6 weeks. this was for the miniscus repair not the Lars.

School was fine, no pain and of the meds by the next Friday.

Stiches came out on the 22 of Sept, and the Doc (again not to sure about Lars ) said that they had healed perfect ( fast for two weeks he said) and he did the motion test and said both knees were the same. He seemed happy.
been a therapy for three weeks now, he has had 90 since week one and wasnt working on the 0. so he was at 10 last week and the therapist gave him heck and said he need to be at 5 by the next time she saw him. That chat seemed to work as as of last Thursday he was at 0

so here we are less than three weeks after he has no pain, 0-90 ROM and plans on going to school Monday with no crutches.

Few other comments, just so you all have as much information as I do.

It was mentioned that Lars has a low newton strength, this is not true. it may be with the old ones but I think we need to focus on todays material. The lars comes in differnt sizes based on age and weight of the patient.
Tests undertaken by the Institute Textile de France (ITF) on range of LARS ligaments demonstrate a total resistance to rupture equal to 2500 N for 60 fibers ligament, 3500 N for 80 fibers ligaments, 4600 N for 100 fibers ligaments and 5000 N for ones consisting of 120 fibers
They also have a 30 for partial tears.

How this procedure is done in Montreal is the ACL is attached to the lars and pulled back to the bone. the lars acts as a support while the acl heals. they do not remove the acl. the stregth is immediate as the lars is there and supports the acl, this i guess why we have read about some soccer players returning with in 8 weeks of the surgery.

Please dont judge us based on what happened in the 80's as this is not the same stuff, medical technology grows over the years anf things change. we did our home work and spoke to many different people up here as we have family members who are doctors. they have been studing this at many universitys here and if you google as much as I did you will see the positive results they have been finding with the new stuff.
It is also based on how fresh the injury is. if you have it done right away the success is 90%  the longer you wait the success drops as the acl has less chance to survive.

the last point I have is most of the patients who ge this done here are Americans. If fact we met a wonderful family when we were there.

I will try to answer any question I can and keep every one updated as we progress.

I know this is voodoo to alot of you but only based on it is not proven, but the studies are there for 10 years and more. Hopefully our journey will give everyone just one more thing to consider.

Kneedad.

Offline Kaputt_Knee

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Re: LARS question
« Reply #18 on: September 27, 2008, 05:42:54 PM »
Thanks for posting KneeDad.

Yours is the first post about the LARs grafts that does not try to sell it or claim preposterous results. I hope you will update us on a regular basis so that in future there is a version based on facts. The first glaring difference I can pick out here is that of the length of the surgery - the promoter was telling us 15 minutes then you run out of the operating theatre (OK that last bit about running out of OP is a tinsey-winsey embellishment of mine  ;) )

I think we are open to new ideas here and will eagerly read about new techniques. Some of us have had many operations and new techniques obviously interest us.

Do you know which gauge of LARS was used for your son? I for one would like to read some of the studies you found while looking at this particular technique. I am not sure as to how the ACL is able to regenerate itself but would like to read more as this looks an interesting alternative especially for young athletes such as your son. I can also see why you were put in the position of making a fast decision, with your comment about the success rates decreasing with time since the rupture. In conventional reconstructions they prefer to operate after the initial swelling in the knee has been reduced in order to improve success rates. So this is the exact opposite - the sooner, the better. That's very interesting. Did your son have a complete or partial rupture by the way?

We have had a lot of wild claims here in the past, some of  which were too fanciful to even pour scorn on. All the references I have read to date have been wary of the use just to bring about a rapid return to sport. The studies I have found have all talked about the tendency for stretching but as yet I have not read of any long term studies. The longest I have read of only went to 3 years post op. Do you have any links to studies that have been made over a longer period as I'm sure stretching occurs in auto- as well as allografts over time? LARS has been around for quite a while so the paucity of long term studies was for me a reason to question its lack of acceptance in mainstream orthopaedics. Long term studies need quite a large number of cases in order to be more accurate and believable, so maybe it is a Catch 22 situation.

I wish your son a very successful and rapid recovery. Make sure he is not too quick returning to cutting and pivoting, especially at or around the 4/6 month stage as that is when a lot of people mess up whatever graft they receive. You feel great, your rehab may have you feeling fitter and fresher than maybe before your operation. Then they return to the high impact cutting and pivoting sport where perhaps the injury occurred and wham, one dead repair!

BTW  I don't believe any of us feel that this technique is "voodoo", we are just concerned when someone seems to be in a hurry to believe the glossy advertising. There is a somewhat similar pro/con thread discussing a new technique that is not quite OK'd yet in the States but has had clearance in Europe for quite a long time. Unlike a lot of "informed" opinion, we have all been through various procedures and know what is involved in terms of the rehabbing. An honest and open exchange of ideas is both healthy and always welcome. If nothing else, maybe our doubts made you dig deeper for information and were therefore in a better position to make an informed opinion in a relatively short time.

Good luck and please keep updating us


Sue  ;) in Germany

PS I am also making a somewhat surprisingly fast recovery from my conventional ACL revision and LCL, PLC reconstruction and am returning to work on Monday, a full six weeks  earlier than planned. I'm six weeks from surgery but will have to wear a brace set at 90° for the next 3 weeks but have full extension and even a little hyper-extension.

1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline kneedad

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Re: LARS question
« Reply #19 on: September 27, 2008, 07:21:50 PM »
Hi.
Nope, there was no dancing out of the operating room.
Surgery is surgery. I would assume this is the same recovery time as any miniscus repair.
They other boy who we met had no miniscus repair and was walking the next day with crutches but could bear some weight, which we were told not to because of the miniscus.

My son had the #60 Lars. It was a complete tear, but the doctor explain the stump was nice and fresh and still very healthy. As you will read in the study they get best results with a repair done less than 6 months old.
He was about 3 weeks. Funny thing is he had the surgery done and was in rehab by the time our local surgeon called to set up an appointment.

The wild claims you spoke of, almost made me not do this. as the saying goes if it is too good to be true it usually is. I did all of my googleing by staying off the LARS sites. Here a a few of the sites.
There are much more these are a sample, there are some from some chineese doctors who are now using it and some from a canadian university McGill that are now looking at it again.

http://www.innovazionemedica.com/download/studi/Duval_ACL_surgery_with_artificial_ligament.pdf
http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ArtikelNr=77256&ProduktNr=223841&Ausgabe=230000&filename=77256.pdf
http://www.jbjs.org.uk/cgi/reprint/84-B/3/356.pdfhttp://www.coa-aco.org/coa_bulletin/issue_74/artificial_ligaments_nicolas_duval.html
http://findarticles.com/p/articles/mi_qa3767/is_/ai_n9032218
http://www.carletonsportsmed.com/June%2001%20newsletter.pdf


The stretching has been addressed by a change in design, they dont weave it any more which stretched, they do it in strands, which also allows tissue growth. cant explain it very well but thats the way I understood what I read.
More people need to try new things, some will work some dont. I remember when I had my knee done 25 years ago, the gold standard was a full leg cast for 8 months. they dont do that any more. I am not telling anyone this is what they should do, I am just saying it it what we did, and maybe someone else may want to look at it. Hopefully we will be your successful long term study. as when he is ready that knee is going to get a beating.

We are not going to rush back to any cutting, just straight line stuff until we strengthen the muscles around the knee, then slowly work into it. the plan is to be 100% by June.

Not to get of topic, but to add to it. The surgeon said no brace. For two reasons one Lars do no require it as from day one it is going to be as strong as ever, second when I told him that I wanted him to wear it while playing, the doctor said to do my home work and I did, found lots of studies that said wearing a brace during football increases the chance of injury to the knee. It was popular in the early 90's but now they are moving away from it as the studies show it makes it worse.
The only person I could find hear that insists on him wearing it was the lady who sold it to us.

Glad to hear you are recovering well.

Kneedad

Offline Kaputt_Knee

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Re: LARS question
« Reply #20 on: September 27, 2008, 07:37:29 PM »
I have to wear the brace because of the Lateral Collateral ligament reconstruction. That is very vulnerable until vasculization has taken place. Normally I would not be wearing one, other than immediately post operatively when it is used to protect the new structures. I was in an immobiliser at first and that was a nightmare!

Thanks for the links I will definitely follow by reading them and adding to my knowledge of the whole system.

Sue
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline miss_sporty

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Re: LARS question
« Reply #21 on: September 27, 2008, 07:46:56 PM »
Glad to hear the recovery is going so well  :), it would definitely be great if you could keep us updated, i for one would be really interested to see the recovery rate etc. thats so interesting about the reattachment of the ACL, i didnt know that they did that.
Hope the good recovery continues :)
Torn ACL
Hamstring graft reconstruction
Patellar tendon graft reconstruction

Offline kneedad

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Re: LARS question
« Reply #22 on: October 02, 2008, 12:19:47 AM »
Hi
Just an update
Today (yesterday) was the full first day no crutches.
I think he could have done it soon, but was a little tentative about going with out.
At the end of the day he says his ankle and calf are sore, probably from lack of use.
Two more weeks of not past 90, then anything goes.

That is it for now

Offline Kaputt_Knee

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Re: LARS question
« Reply #23 on: October 04, 2008, 10:07:30 AM »
That's good news Knee Dad

What is the rehab protocol like for things like strengthening or keeping the knee mobile? Is he having regular physiotherapy?

I'm really interested in following this procedure as it seems that they are using the LARS not to replace the ligament but to augment the natural structures. I think that is how it was used with one of the youngster who had her PCL augmented in this way. (Sorry I know it was either Miss_Sporty or Vicky but can't remember which  ::) )

How is he doing now with the full weight-bearing?

Please keep posting and wish your son all the best from us - we know what he is going through from personal experience  ;D ;D

Sue  ;) in Germany


1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline kneedad

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Re: LARS question
« Reply #24 on: October 04, 2008, 02:14:15 PM »
Hi

As of today he is walking like nothing is wrong. He sometimes looks a bit odd as he is focusing on a normal gate and not swinging his leg like he did on crutches. He can stand alone on the repaired leg without any problem. I read some where that the PCL repair is just as popular ( cant remember the article. Also one of the University hospitals here have said they are going to start using it on PCL repairs.

He goes to physio twice a week and does his exercises each day on his own ( or should be)
They do the electronic stimulation on the quad, Straightening exercises, and a bit of bike, with the seat up high so he does not go past 90 ( which he could if he wanted)

I spoke to the Dr. this week to double check his limitations, as he has it in his head he could be back for play offs. Dr. said no twisting until six months, then start running figure 8's then make them smaller and smaller.

So no football training until Dec. This gives him plenty of time to be ready for the summer combines and camps.
His spirits are great and he has no pain at all ( just 4 little scars)

I am thinking of looking for an other pysio place as I am not impressed with this one. the tech works with 4 or 5 patients at the same time. The Dr. wanted aggressive physio and I dont think we are getting it.

All else is good

Kneedad

Offline Kaputt_Knee

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Re: LARS question
« Reply #25 on: October 04, 2008, 02:39:34 PM »
Thanks KD. It's good to hear that despite the claims elsewhere this seems to be a fairly standard rehab protocol.

Maybe if you ask here about good Physio Centres somebody might be able to recommend someone in your neck of the woods. I would suggest posting in the General area with a new thread. A good physio, especially with an aggressive rehab protocol is worth their weight in gold.

Good luck in reining your boy in  ;D


Sue
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline badkneesqueen

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Re: LARS question
« Reply #26 on: October 15, 2008, 06:55:18 AM »
I am very happy to see the latest posts about Lars and the information from kneedad.  I feel like I can totally identify with kneedad in all the agonizing turmoil and frustration in researching the LARS procedure.  I, too have been searching the web for months looking for the negatives on LARS.  I have talked to the northern california mom whose son had the surgery and the LARS sales men in Montreal.  Are their filters needed? oh yes.  Where in our world of greed and money do we not have to be on the watch  on who ever is marketing their wares? whether it be the local hospital and doctors or the high and fancy specialty clinics Steadman-Hawkins etc.  We are inundated with marketing that prey on the down and out. 

Our story..I am the mother of a 17 year old who has now torn his ACL 3 times in the same knee.  The latest was in his vey first basketball game back after 12 months of rehab in June, 08.  Talk about devastation.  Both of his knees surgeries (Oct, 2007 and June, 2007) were the standard ACL reconstruction.  The first was with a hamstring tendon (retore in March of 08, not able to pinpoint when or how) and the 2nd was an allograft.  When we read about all the negative LARS blogs we try very hard to find a fact or statistic to persuade us to do a third "standard" ACL reconstruction.  All we read are peoples feelings or subjective thoughts concerning LARS. We are not convinced and have been thoroughly disappointed in my sons outcomes, especially after he worked so hard to rehab.  I also feel we do not hear about all the negative outcomes of the standard ACL repair auto or allograft from our doctors.  I wish there was a web site that patients could log on successes and failures by city and doctor. 

It would be cheaper for us to have our insurance company pay for another surgery in the states and another long rehab.  The moral of the story is there are go guarantees and my son and I feel that he has already been subjected to very poor outcomes and the LARS option combined with his quadriceps tendon would be worth the try.  He obviously was not able to play football this season again so has been running cross country (no pivoting or twisting) and we are hoping to have the surgery in Montreal after State Cross Country ( he has qualified already) at the end of October.  Kneedads updates are very helpful to us with out the sugarcoating.  We have also been following Australian Swan rugby player Nick Malceski and his return to playing after only 90 or so days after LARS surgery.  The season is just ending or has ended and he apparently was a key player on the team.

Offline kneedad

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Re: LARS question
« Reply #27 on: October 20, 2008, 09:22:18 PM »
Badkneesqueen, sorry to hear about your son. Making the choice for our children is harder than the surgery itself.
If you have any questions concerning Montreal just ask, If I know the answer I will tell you.

My son is now 6 weeks post Lars and is on the bike and jogging. He has been given permission to run circle eights ( not to small) and do hamstring curls, and calf raises in the gym. No heavy squats or leg extensions.

At 3 months ( Dec 8) then he can do what ever he wants.

All else is good ( other than his team is 3-2 with out him)

Stay tuned

Kneedad.

Offline kneedad

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Re: LARS question
« Reply #28 on: November 03, 2008, 07:52:28 PM »
 ;D 8 week post Lars Op.

He is now only going to rehab one day a week as he has 100% ROM.

Actuly, it is better than the good leg. Has no hyper extension and 1 degree more bent.


Spirits a great, in the gym 5 days a week, running etc.
The real heavy weights are still on hold until Dec 9

then it is full tilt.

First Combine will be in Dec. Looking forward to it.

got an email from the family that was there after us. Her son is back kicking in games (football) after 7 weeks. He did not have any miniscus work, so his recovery was faster.

Hope every one is good.

Kneedad

Offline badkneesqueen

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Re: LARS question
« Reply #29 on: November 05, 2008, 03:35:20 AM »
Thanks again kneedad for the update.  We have just gotten all the information that the dr in Montreal requested for my son his MRI, xrays and today his operation notes from his last surgery to determine screw size.  His options now are the quadriceps tendon with the LARS.  Cross Country is over and it is time to get his knee stabilized again.  Passports are in place and today we found our insurance will not cover this out of country procedure.  All the updates we get are encourageing from you and we will do the same.  Our prelim cost estimate is around $14,000, hopefully I will get a better handle on this in the days to come. We are just waiting to hear from the doctor and the scheduleing time so we can book our flights.