Massive foreign body reaction and osteolysis following primary anterior cruciate ligament reconstruction with the ligament augmentation and reconstruction system (LARS): a case report with histopathological and physicochemical analysis

BMC Musculoskeletal Disorders

Case Report

Lorenzo Nibid¹  Carla Rabitti¹  Kristian Samuelsson²  Rachele Castaldo³  Luigi Ambrosio³  Gennaro Gentile³  Vincenzo Denaro⁴  Rocco Papalia⁵  Gianluca Vadalà⁵  Luca Ambrosio⁵  Edoardo Franceschetti⁵  Eric Hamrin Senorski⁶ 

[1] Department of Human Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy;Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden;Sahlgrenska Sports Medicine Center, Gothenburg, Sweden;Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden;Institute of Polymers, Composites and Biomaterials, National Research Council, Naples, Italy;Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy;Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy;Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy;Sahlgrenska Sports Medicine Center, Gothenburg, Sweden;Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;

关键词: LARS;    ACL;    Ligament;    Reconstruction;    Case report;    Complications;    Synthetic;    Graft;   

DOI  :  10.1186/s12891-022-05984-5

 received in 2022-07-23, accepted in 2022-11-14,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundAutologous hamstrings and patellar tendon have historically been considered the gold standard grafts for anterior cruciate ligament reconstruction (ACLR). In the last decades, the utilization of synthetic grafts has re-emerged due to advantageous lack of donor site morbidity and more rapid return to sport. The Ligament Augmentation and Reconstruction System (LARS) has demonstrated to be a valid and safe option for ACLR in the short term. However, recent studies have pointed out the notable frequency of associated complications, including synovitis, mechanical failure, and even chondrolysis requiring joint replacement.Case presentationWe report the case of a 23-year-old male who developed a serious foreign body reaction with wide osteolysis of both femoral and tibial tunnels following ACLR with LARS. During first-stage arthroscopy, we performed a debridement of the pseudocystic mass incorporating the anterior cruciate ligament (ACL) and extending towards the tunnels, which were filled with autologous anterior iliac crest bone graft chips. Histological analysis revealed the presence of chronic inflammation, fibrosis, and foreign body giant cells with synthetic fiber inclusions. Furthermore, physicochemical analysis showed signs of fiber depolymerization, increased crystallinity and formation of lipid peroxidation-derived aldehydes, which indicate mechanical aging and instability of the graft. After 8 months, revision surgery was performed and ACL revision surgery with autologous hamstrings was successfully carried out.ConclusionsThe use of the LARS grafts for ACLR should be cautiously contemplated considering the high risk of complications and early failure.

【 授权许可】

CC BY   
© The Author(s) 2022

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