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ACL Injury and Artificial Ligaments

Question: ACL Injury and Artificial Ligaments

I injured my knee a long time ago skiing, most likely at least a partial ACL tear. I did NOT get the surgery, electing instead to do extensive rehab and conditioning. Lasted pretty well for 15 years of reasonably active athletic habits (running, bicycling, rock climbing, hiking). Even climbed Mt. Rainier.

Just a few weeks ago though I was playing with a new soccer group, and got spun around from a contact hit just as my foot had hit the astroturf, and I heard a popping sound in the knee ... MRI confirms that even if it was not fully torn before it sure is now ... looks like surgery for sure.

So, I am reading on this site about the various options before I meet the surgeon tomorrow. Bone-patellar-bone seems to be the most common option. But I have been reading up also on advances in artificial ligaments such as the LARS Ligament:

http://www.larsligament.com/about-knee-ligaments.html

I read the Owen Anderson article on here that itemizes the pros and cons of the various options. For the artificial ligaments, he notes that many of these materials suffer from what he calls "creep" which (as an engineer) I would call plastic deformation, the part of your stress-strain curve where applied stress imparts a permament change to the material. Elastic deformation on the other hand, snaps back. It's easy to see this with a rubber band, there is a point where it will always retain its original dimension, but once you push it further, it begins to stretch permanently, and eventually break.

While I think I could be willing to give up contact sports such as soccer, which puts you in vulnerable positions where you can sustain considerable dynamical stress loading from hits, I also frequently participate in martial arts classes such as Aikido where kneeling is a necessary position sometimes for a long period of time. I am concerned about the noted susceptability to knee pain when kneeling. Also my love of hiking and rock climbing tends to need full flexibility.

It sounds like the artificial approach is the best for the short term but not necessarily the best for the long term, whereas the bone-patellar-bone appears to be the best for the long term, but leads to the possibility of knee pain at the location where the patellar and bone sections were removed.

So my question is, what are people's experiences with artificial ligaments and have there been enough advancements in the materials science of the ligament fibers such that it would be worth going down this path, or does the bone-patellar-bone still make the most sense in spite of the downside?

- Ed

Answer:

I don't know much about the artificial ligaments but I received an allograft 6 years ago from one of the top sports knee surgeons and it has turned out wonderfully. My once shreaded knee (torn cartlige, chipped bone, arthritis) is now repaired and pain free.

He strongly excouraged slow rehab so as keep the ligament tight. I "retired" from court and contact sports but eventually took up distance running and will be running a marathon this winter.

Answer:

Hi,
this was asked quite a while ago, but thought i would reply anyway. i have had a LARS, but it was alongside a normal four strand hamstring graft for additional strength-my surgeons idea as my graft keep failing. this one two failed, though i dont think it was due to the LARs or anything... i will be having a LARS and quadriceps graft again soon in fact.

the synthetics today are much different from how they were, but still not as good as the normal tissue grafts which are obviously closer to the real thing. along with a tissue graft they are very good though as they provide extra strength, along with a scafold for the tissue graft to grow along when is revascularises and becomes part of the knee.

hope this was useful.

Answer:

My son had an acl-pcl-mcl repair almost 4yrs ago using LARS. He walked out of the hospital on the 2nd day without crutches or a brace, returned to sports 6 weeks post-op. He has had no problems--no regrets.

Answer:

Have you looked into the knee operation success and spoken to people who have had it done. I have a few friends who have had knee surgery none of which have had an improvement after the op, but I guess there is more than one kind of knee surgery.
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