This past spring, Mat Hoffman told the story of how in 1999, he tore his ACL underwent surgery without anesthesia to receive a synthetic ligament. Because the LARS™ ligament was banned in the U.S., he had to go to Canada. The video, illustrated by Taj Mihelic, described why there was no anesthesia and what made it so revolutionary for him. It piqued my interest in the LARS™ ligament so I did a little digging about its history and current studies.
The Ligament Advanced Reinforcement System, or LARS™, was developed in 1992 with hopes of solving problems with synthetic ligaments in the past decade (Corin). Those often failed or caused inflammation in the synovial membrane that lines the joints (Machotka et al. 2010). The LARS™ ligament was made from terephthalic polyethylene polyester fibers that are twisted for increased durability.
When Mat received his LARS™ ligament, the procedure was still relatively new. It made headlines in Australia around 2010, as more professional athletes got LARS™ ligaments and enjoyed the speedy recovery. That’s not to say there weren’t critics. Moreover, the FDA has yet to approve it.
Reviews of clinical studies thus far lean towards positive outcomes. Batty et al. and Chen at al. have compared the efficacy of many types of synthetic ligaments, and the LARS ligament produced the lowest rate of failure. The results reinforces the idea that this could be a solution to the severe side effects experienced with its predecessors. One issue appears to be the long-term durability. A study by Tiefenboeck et al. published this year examined patients who had their ACL reconstructed with the ligament with at least a ten-year follow-up reveals that re-rupturing does occur. They do not recommend the LARS™ ligament for primary ACL reconstruction. This is, however, just one study. As more results are published and more patients are observed in the long run, a better idea of the uses and limitations of the LARS™ ligament will be known. In Mat’s case, it appears to be a great success.
- Batty LM, Norsworthy CJ, Lash NJ, Wasiak J, Richmond AK, Feller JA. 2015. Synthetic devices for reconstructive surgery of the cruciate ligaments: a systematic review. Arthroscopy. 31(5):957-68.
- Chen J, Xu J, Wang A, Zheng M. 2009 Scaffolds for tendon and ligament repair: review of the efficacy of commercial products. Expert Review of Medical Devices. 6(1):61-73.
- Corin – “LARS™ (Medical professionals)”
- Machotka Z, Scarborough I, Duncan W, Kumar S, Perraton L. 2010. Anterior cruciate ligament repair with LARS (ligament advanced reinforcement system): a systematic review. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology. 2:29.
- Tiefenboeck TM, Thurmaier E, Tiefenboeck MM, Ostermann RC, Joestl J, Winnisch M, Schurz M, Hajdu S, Hofbauer M. 2015. Clinical and functional outcome after anterior cruciate ligament reconstruction using the LARS™ system at a minimum follow-up of 10years. Knee. pii: S0968-0160(15)00131-3.