Anterior cruciate ligament reconstruction: a systematic review of polyethylene terephthalate grafts

Abstract

The ligament advanced reinforcement system (LARS) ligament is an artificial polyester ligament made from polyethylene terephthalate (PET) that is used for primary anterior cruciate ligament (ACL) reconstructive surgery. Recent media attention has resulted in a high awareness of this reconstructive option among patients; however, the outcomes compared with autograft are controversial. A systematic review of the literature was undertaken to examine the outcomes following LARS and long-term PET artificial grafts in ACL reconstructive surgery. The ultimate objective was to determine whether the LARS ligament should be incorporated into routine practice. A systematic search strategy from 1970 to June 2010 was used to retrieve relevant studies. Inclusion of articles was established through application of a predetermined protocol, independent assessment by two reviewers and a final consensus decision. Twelve articles met the inclusion criteria for the LARS ligament. The methodology of the identified articles was poor. Only short-term outcomes were available. These results were good with low complication rates. Eleven articles reported on other PET grafts and recorded long-term follow-up of more than 4 years. These grafts had poor outcomes and a high rate of complications. No meta-analysis was possible. There are surprisingly few studies reporting on LARS ligament outcomes. The literature has poor methodological quality. Short-term results for the LARS ligament appear good, with faster recovery times compared with autografts. Final short-term results are not significantly different from autograft. There is real concern that late failure and iatrogenic osteoarthritis may occur based on the results of other PET grafts.