Through-tunnel reconstruction with Ligament Augmentation and Reconstruction System (LARS) for managing post-arthroplasty patellofemoral instability
Abstract Background Despite advancements in prosthetic designs and surgical techniques, patellar dislocation remains a rare but significant complication following total knee arthroplasty, with an incidence ranging between 0.15% and 0.5%. This condition often requires revision surgery to alleviate di...
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BMC
2025-01-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-024-08250-y |
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| author | Jung-Hsiu Chang Chih-Hui Chen Yi-An Li |
| author_facet | Jung-Hsiu Chang Chih-Hui Chen Yi-An Li |
| author_sort | Jung-Hsiu Chang |
| collection | DOAJ |
| description | Abstract Background Despite advancements in prosthetic designs and surgical techniques, patellar dislocation remains a rare but significant complication following total knee arthroplasty, with an incidence ranging between 0.15% and 0.5%. This condition often requires revision surgery to alleviate discomfort and restore joint function. Among the methods to address patellofemoral instability, medial patellofemoral ligament reconstruction has gained attention. In this case, we present the first report of using the synthetic Ligament Augmentation and Reconstruction System (LARS; Surgical Implants and Devices, Arc-sur-Tille, France) for medial patellofemoral ligament reconstruction following patellar dislocation after total knee arthroplasty, offering a novel approach to avoid donor site morbidity. Case presentation An 87-year-old man with no significant comorbidities underwent NexGen posterior-stabilized-total knee arthroplasty (Zimmer Biomet, Warsaw IN) for advanced osteoarthritis in his left knee. Three months postoperatively, he experienced a persistent giving-way sensation and swelling in the knee after a fall. Physical examination revealed patellar subluxation, confirmed by imaging studies. A computed tomography scan showed no malrotation of the femoral or tibial components. The patient was diagnosed with a medial patellar retinacular tear and medial patellofemoral ligament rupture. He underwent medial patellofemoral ligament reconstruction using a Ligament Augmentation and Reconstruction System (LARS; Surgical Implants and Devices, Arc-sur-Tille, France) synthetic ligament, and the medial retinaculum was repaired. After a year of follow-up, the patient reported satisfactory knee stability, with no recurrence of patellar dislocation. Conclusion This case demonstrates the successful use of a synthetic Ligament Augmentation and Reconstruction System for Medial patellofemoral ligament reconstruction in managing post-arthroplasty patellar dislocation. It offers a less invasive alternative to autograft harvesting, reducing donor site morbidity while providing effective stabilization of the extensor mechanism. This approach could have significant clinical implications, particularly for elderly patients with compromised bone healing capacity. |
| format | Article |
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| institution | Kabale University |
| issn | 1471-2474 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | BMC Musculoskeletal Disorders |
| spelling | doaj-art-0d33807a33084042a7566da71cf398a22025-01-05T12:04:51ZengBMCBMC Musculoskeletal Disorders1471-24742025-01-012611710.1186/s12891-024-08250-yThrough-tunnel reconstruction with Ligament Augmentation and Reconstruction System (LARS) for managing post-arthroplasty patellofemoral instabilityJung-Hsiu Chang0Chih-Hui Chen1Yi-An Li2Department of Medical Education, Division of General Practice, Changhua Christian HospitalDivision of Orthopedic Surgery, Changhua Christian HospitalDivision of Orthopedic Surgery, Changhua Christian HospitalAbstract Background Despite advancements in prosthetic designs and surgical techniques, patellar dislocation remains a rare but significant complication following total knee arthroplasty, with an incidence ranging between 0.15% and 0.5%. This condition often requires revision surgery to alleviate discomfort and restore joint function. Among the methods to address patellofemoral instability, medial patellofemoral ligament reconstruction has gained attention. In this case, we present the first report of using the synthetic Ligament Augmentation and Reconstruction System (LARS; Surgical Implants and Devices, Arc-sur-Tille, France) for medial patellofemoral ligament reconstruction following patellar dislocation after total knee arthroplasty, offering a novel approach to avoid donor site morbidity. Case presentation An 87-year-old man with no significant comorbidities underwent NexGen posterior-stabilized-total knee arthroplasty (Zimmer Biomet, Warsaw IN) for advanced osteoarthritis in his left knee. Three months postoperatively, he experienced a persistent giving-way sensation and swelling in the knee after a fall. Physical examination revealed patellar subluxation, confirmed by imaging studies. A computed tomography scan showed no malrotation of the femoral or tibial components. The patient was diagnosed with a medial patellar retinacular tear and medial patellofemoral ligament rupture. He underwent medial patellofemoral ligament reconstruction using a Ligament Augmentation and Reconstruction System (LARS; Surgical Implants and Devices, Arc-sur-Tille, France) synthetic ligament, and the medial retinaculum was repaired. After a year of follow-up, the patient reported satisfactory knee stability, with no recurrence of patellar dislocation. Conclusion This case demonstrates the successful use of a synthetic Ligament Augmentation and Reconstruction System for Medial patellofemoral ligament reconstruction in managing post-arthroplasty patellar dislocation. It offers a less invasive alternative to autograft harvesting, reducing donor site morbidity while providing effective stabilization of the extensor mechanism. This approach could have significant clinical implications, particularly for elderly patients with compromised bone healing capacity.https://doi.org/10.1186/s12891-024-08250-yPatella dislocationPost-arthroplastyPost-TKATotal knee arthroplastyPatellofemoral instabilityArtificial ligament |
| spellingShingle | Jung-Hsiu Chang Chih-Hui Chen Yi-An Li Through-tunnel reconstruction with Ligament Augmentation and Reconstruction System (LARS) for managing post-arthroplasty patellofemoral instability BMC Musculoskeletal Disorders Patella dislocation Post-arthroplasty Post-TKA Total knee arthroplasty Patellofemoral instability Artificial ligament |
| title | Through-tunnel reconstruction with Ligament Augmentation and Reconstruction System (LARS) for managing post-arthroplasty patellofemoral instability |
| title_full | Through-tunnel reconstruction with Ligament Augmentation and Reconstruction System (LARS) for managing post-arthroplasty patellofemoral instability |
| title_fullStr | Through-tunnel reconstruction with Ligament Augmentation and Reconstruction System (LARS) for managing post-arthroplasty patellofemoral instability |
| title_full_unstemmed | Through-tunnel reconstruction with Ligament Augmentation and Reconstruction System (LARS) for managing post-arthroplasty patellofemoral instability |
| title_short | Through-tunnel reconstruction with Ligament Augmentation and Reconstruction System (LARS) for managing post-arthroplasty patellofemoral instability |
| title_sort | through tunnel reconstruction with ligament augmentation and reconstruction system lars for managing post arthroplasty patellofemoral instability |
| topic | Patella dislocation Post-arthroplasty Post-TKA Total knee arthroplasty Patellofemoral instability Artificial ligament |
| url | https://doi.org/10.1186/s12891-024-08250-y |
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