Lars ACL

Indications

 

Intact but lax ACL with symptomatic instability

 

ACL Old Partial Tear Taut with Anterior Draw ArthroscopyArthroscopy Lax ACL

 

Acute ACL rupture

 

Partial Tears

 

ACL Partial Torn Arthrocopy

 

Aim

 

To pass LARS graft up intact ACL / ACL remnant

- all reaming outside in to preserve ACL

- provide a LARS scaphold for the injured ACL to heal onto

 

Technique

 

Set up

- knee 90o over bolster

- II with perfect lateral of knee

- superimposed femoral condyles

- standard arthroscopy portals

- can be difficult to set up II and arthroscopy tower together

- do so before beginning operation

 

Femoral entry point

- place beath pin just medial to patella tendon

- insert into femoral insertion of ACL on LFC

- check entry on lateral

- imagine posterior femoral condyle as circle

- entry point in centre, but 60% of distance posterior

- can also look inside knee with scope to confirm insertion

- drive out lateral femur as standard

- pull pin back through femur so that guide wire passes up into femur

- distal pin now in joint

 

Lars ACL Femoral Entry PointLars ACL Femoral Entry Point 2Lars ACL Femoral Entry Point 3

 

 

Tibial entry point

- extend knee

- aim pin for standard origin of ACL

- drive through tibia

 

Lars Tibial PinLars ACL Guide Wire Clinical Photo

 

Select Lars graft

- variety of sizes

- 7 - 8 mm

- fibre numbers 80 - 120

 

Ream tibial and femoral tunnels

- line to line to graft size

- outside in to preserve native ACL

 

Lars Femoral ReamerLars ACL Tibial Ream

 

Pass graft

- measure tibial tunnel

- apply artery forcep at appropriate distance from central graft

- allows you to know when graft is pulled through enough

- the LARS has a specifice portion designed to be inside the native ACL

- pass from the tibia up through the knee into the femur

 

Lars ACL Pass Graft 1Lars ACL Pass Graft 2Lars ACL Pass Graft 3

 

Secure

- insert femoral screw outside in

- tension tibial side

- must not overtension as there is no give in the graft

- secure tibial side with screw

 

Lars ACL Post op Xray APLars ACL Post Op Xray Lateral