使用LARS重建ACL简报-Dr Duval(2003).ppt

ACL reconstructionwith LARS Nicolas Duval, MD, FRCS(C) Private practice Montréal, Canada Overview History of artificial ligaments LARS ligament Patient satisfaction needs as related to knee stability and objective findings after reconstruction with LARS Prospective randomised trial: LARS vs PBTB for chronic ACL tear History of artificial ligaments DiGiovine Shields (1991) excellent results during biomechanic testing enthusiastic preliminary clinical results overimplantation period History of artificial ligaments complications recognized clinical failures abandonment of the ligament return to a conventional ACL reconstruction technique History of artificial ligaments Reasons for artificial ligaments failures (Chaput Duval, 1997) 1 - Bad material 2 - Bad textile structure 3 - Bad surgical technique LARS ligament Material Terresuisse polyester Textile structure Multifilament between knitted ends LARS ligament Evolution in surgical technique Early: 1993 - 1997 Large sizes: 100 - 120 fibers Large tunnels: 7.0 - 7.5 mm Interference screws in oblique tunnels Surgical guide vs C-arm LARS ligament Evolution in surgical technique Actual: 1997 - Smaller sizes: 60 - 80 fibers Smaller tunnels: 5.5 - 6.0 mm Tibial interference screw in blunt transverse tunnel Always use C-arm LARS ligament Surgical technique LARS ligament Personal experience 1993-2003 401 procedures 313 ACL reconstructions Patient satisfaction needs as related to knee stability and objective findings after ACL reconstruction Part one ...using the LARS artificial ligament Lavoie P, Fletcher J, Duval N. The Knee 7 (2000) Part two ...using a patellar tendon autograft Lavoie P, Fletcher J, Duval N. (The Knee 8 (2001) ...using the LARS ligament Purposes compare patient satisfaction with the objective measurement of knee stability assess early complications following ACL reconstruction with LARS ...using the LARS ligamentStudy population 47 reconstructions between November 1993 - November 1996 Evaluation