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

• DOI: 10.1186/s12891-022-05984-5
• Publication Date: 2022-12-30T02:02:27Z
• Authors: Luca Ambrosio; Gianluca Vadalà; Rachele Castaldo; Gennaro Gentile; Lorenzo Nibid; Carla Rabitti; Luigi Ambrosio; Edoardo Francesch...; Kristian Samuelsson; Eric Hamrin Senorski; Rocco Papalia; Vincenzo Denaro
• Keywords: Male; Adult; Complications; Anterior Cruciate Ligament Reconstruction; ACL; Anterior Cruciate Ligament Injuries; Foreign-Body Reaction; Synthetic; Case Report; Diseases of the musculoskeletal system; LARS; Osteolysis; 3. Good health; Graft; Young Adult; 03 medical and health sciences; 0302 clinical medicine; RC925-935; Case report; Humans; Ligament; Reconstruction; Anterior Cruciate Ligament

AbstractBackgroundAutologous 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.