Revision ACL reconstruction guided by 3D printed preoperative templating: comparison of outcomes between bone-patellar tendon-bone autograft and Ligament Augmentation and Reconstruction System (LARS) ligament.

OBJECTIVE

To select the grafts using three-dimensional printed (3DP) preoperative templating and compare the outcomes between the Ligament Augmentation and Reconstruction System (LARS) ligament and Bone-Patellar Tendon-Bone (BPTB) autograft in revision ACL reconstruction.

METHODS

Patients underwent revision ACL reconstruction between January 2019 and December 2021 were selected. The direction of the new and primary bone tunnel, overlap ratio of the intra-articular femoral tunnel aperture between new tunnels of different diameters and primary tunnels and graft choice for revision ACL reconstruction were studied. The patient-reported outcome scores included Tegner activity level, Lysholm and IKDC score. The objective evaluation measures included the Lachman test, the pivot shift test, the anterior tibial translation (ATT) and the rate of return to sport.

RESULTS

A total of 59 patients (26 cases with LARS artificial ligament and 33 cases with BPTB) were enrolled. There were no statistically significant differences in subjective evaluation indexes between the two groups. In addition, the postoperative ATT measurements, Lachman and pivot shift test in LARS group were better than the BPTB group (P < 0.05). The rate of return to sport of LARS and BPTP group were 76.9% vs. 48.5% (P < 0.05) at one year after surgery and 88.5% vs. 81.8% (P > 0.05) at one year after surgery.

CONCLUSIONS

The 3DP preoperative templating can accurately select graft of LARS ligament or BPTB autograft. Both of these ligaments can achieve great outcomes in revision ACL reconstruction. Under the reasonable selection of grafts and the management of combined injuries, the LARS ligament has more advantages of restoring knee stability and early return to sport in short term follow-up. TRIAL REGISTRATION: ChiCTR2500095925 (Registration Date: 1/15/2025).