Acute patellar ligament reconstruction with the synthetic LARS ligament as an internal stabilizer

Background: Acute patellar ligament ruptures present significant surgical challenges due to the essential role of the knee extensor apparatus in gait and postural stability. While direct repair is standard, compromised tissue quality from chronic tendinosis or high functional requirements in athletes may necessitate augmented reconstruction to prevent failure and allow accelerated rehabilitation.

Objective: This article describes a surgical technique for reconstructing the patellar ligament using longitudinal synthetic polyethylene terephthalate (PET) fibers as an internal stabilizer for both acute and chronic injuries.

Key Points: The technique utilizes two LARS PTR 30 ligaments, each providing a tensile strength of 1500 N with 9% elasticity. The procedure involves creating two parallel 4.5 mm longitudinal tunnels in the patella and two tunnels at the tibial tubercle. The synthetic ligaments are anchored proximally via stainless-steel barrettes at the superior patellar pole and secured distally in the tibia using 5.2 x 30 mm metal interference screws. This internal bracing allows for end-to-end suture of the native ligament stumps under reduced tension. Postoperative management includes immediate weightbearing in an extension brace, followed by progressive range-of-motion exercises starting at two weeks. Advantages include the absence of donor site morbidity, high resistance to plastic deformation, and histological evidence of fibroblast ingrowth into the PET mesh.

Conclusion: Internal stabilization with synthetic PET ligaments provides a high-strength alternative for patellar tendon reconstruction. This approach facilitates early mobilization and rapid return to activity, particularly in complex cases or high-demand patients where native tissue quality is suboptimal.