2019SCIENCELINE  
Journal of Life Science and Biomedicine  
J Life Sci Biomed, 9 (4): 109-116, 2019  
License: CC BY 4.0  
ISSN 2251-9939  
Comparative study of two methods of anterior cruciate  
ligament reconstruction with lavsan (polyethylene  
terephtalate)  
Murodjon Ergashevich IRISMETOV, Farrukh Makhamadjonovich USMONOV, Dilshod Fayzakhmatovich  
SHAMSHIMETOV, Alisher Mukhammadjonovich KHOLIKOV, Kurbon Nurmamatovich RAJABOV, Murodjon  
Bakhodirovich TADJINAZAROV  
Department of Sports Traumatology, Republican Spezialized Scientific and Practical Medical Centre of Traumatology and Orthopaedics Uzbekistan,  
Tashkent  
Corresponding author’s Email: farruhtravm@rambler.ru  
ABSTRACT  
Original Article  
PII: S225199391900017-9  
Introduction. The anterior cruciate ligament (ACL) is one of the main stabilizateur of the  
knee joint. Many methods were suggested for its reconstruction with different  
allo/autografts, as well as synthetic materials. Aim. The study aimed to compare two  
Rec.  
Rev.  
Pub.  
15 June 2019  
22 July 2019  
25 July 2019  
methods of ACL reconstruction with lavsan (polyethylene terephtalate). Methods. The study  
included 102 patients who underwent ACL reconstruction with lavsan tape (polyethylene  
terephtalate). Group 1 (46 patients) underwent single-bundle ACL reconstruction, and group  
2 (56 patients) underwent double-bundle reconstruction. Patients were evaluated with  
Lachman, anterior drawer and pivot-shift tests and Lysholm score. Results. Our results  
showed better results in double-bundle group, especially rotational stability was significant  
better. Besides that majority of patients of I group had some problem flexion of the operated  
knees. Conclusion. Independent of the method of ACL reconstructions these surgeries must  
be perform taking into account anatomic features and changes of the knee. Double-bundle  
technique of ACL reconstruction with lavsan provides better stability than single-bundle  
technique.  
Keywords  
Anterior Cruciate  
Ligament, Single-Bundle  
Technique, Double-  
Bundle-Technique,  
Synthetic Material  
Abbreviations: ACL: Anterior cruciate ligament, BTB: Bone-tibia-bone, LARS: Ligament advanced reinforcement system,  
AM: Antero-medial, PL: Postero-lateral  
INTRODUCTION  
Anterior cruciate ligament is one of the stabilizing structures of the knee. The incidence of ACL ruptures  
increased in recent times, and today ACL reconstruction is one of most frequently performed surgeries in  
orthopaedics [1]. ACL ruptures may lead instability of the knee which results in disability of the knee in cutting  
and pivoting activities [2]. Unstable knee after ACL ruptures result in following meniscus injuries, degenerative  
changes of articular surfaces of knee [2, 3]. The goal of ACL reconstruction is stabilization of the knee; minimize  
risk factors of the risk of re-injury, to return previous activity of sportsmen. At present time, single and double-  
bundle methods of ACL reconstruction are used. Each technique has its indications and contraindications [2].  
It is necessary to take into account anatomic and individual characteristics of the patient to choose a method of  
surgery.  
A single-bundle ACL reconstruction means to restore the native anatomy of ACL as closely as possible and  
to achieve normal knee biomechanics [2]. In order to achieve it is necessary to follow the following principles: 1)  
to observe and to objectify native anatomy of patients; 2) to individualize each surgery according patient’s  
anatomy; 3) to place the tunnels and grafts at in the centre of patient’s footprints; 4) to re-establish knee  
biomechanics by tensioning of the graft. In this method femoral and tibial tunnels must be positioned midway  
between the centres of AM and PL insertion sites.  
Double-bundle reconstruction of ACL is explained with anatomic structure of ACL. ACL consists of two  
parts: antero-medial (AM) and postero-lateral (PL) bundles [1]. Both bundles are synergists but in different  
position of the knee they have different functions. Insufficiency of AM bundle shows increased antero-posterior  
translation of the tibia like in complete ACL rupture. Insufficiency of PL bundle results in instability with  
pivoting and turning. In double-bundle ACL reconstruction AM and PL tunnels are drilled separately at the  
Citation: Irismetov ME, Usmonov FM, Shamshimetov DF, Kholikov AM, Rajabov KN, Tadjinazarov MB. 2019. Comparison of two methods of anterior cruciate  
ligament reconstruction with lavsan (polyethylene terephtalate). J Life Sci Biomed, 2019; 9(4): 109-116; www.jlsb.science-line.com  
109  
native femoral and tibial sites. In both methods femoral tunnels can be drilled with using a transtibial or medial  
portal technique [1, 2]. Double-bundle reconstruction of ACL introduced to achieve better stability, particularly  
more stability for rotator loads [4, 5]. Some studies demonstrated that inability of single bundle reconstruction  
to restore intact knee rotational stability [1]. But there are studies that don’t show differences between a single-  
bundle and double-bundle technique, when placed anatomically and customized to the patient’s anatomy [6-9].  
Despite at present time ACL reconstruction with auto- and allografts is popular, synthetic artificial  
ligaments are still used [3]. One of them is polyethylene terephtalate (lavsan), there are many reports about ACL  
reconstruction with this artificial ligament. Lavsan is a non-absorable synthetic material containing  
polyethylene terephtalate fibres [10]. The use of artificial ligaments based on lack of donor comoridity, reduced  
operation time, abundant supply and enough strength and early loading of the operated extremity that result in  
shortening of rehabilitation period [3, 11-13]. Parchi et al. [14] proposed the use of a synthetic graft for the ACL  
reconstruction to all patients older than 30 years with a symptomatic isolated ACL injury in order a quick  
return to their previous sport activity level as a possible alternative to the autograft. Pan et al. [15] reported  
about the similar results obtained at midterm follow-up in groups between bone –patellar-bone (BTB) and LARS  
groups. Huang et al. [13] concluded that the LARS articficial ligament has excellent biomechanical properties in  
comparing with autologous and allogenic tendons that means LARS artificial ligament can be widely used for  
ACL reconstruction. Therefore, the aim of study was to compare two methods of ACL reconstruction with  
lavsan (polyethylene terephtalate).  
MATERIAL AND METHODS  
Our study was included 102 patients with ACL rupture who underwent ACL reconstruction with synthetic  
material (lavsan tape). Assessment was made with Lachman, anterior drawer and pivot-shift tests and Lysholm  
knee scoring scale. First group included 46 patients (42 male, 4 female) who underwent single-bundle (SB)  
technique. Lachman test was positive in all patients of this group: 3-5 mm (n=32), 6-10 mm (n=14). Anterior  
drawer test was negative in 4 patients, posititive 3-5 mm (n=32), 6-10 mm (n=10). Pivot shift was negative in 18  
patients, positive 1+ (n=20), positive 2+ (n=8). A mean Lysholm score on this scale ranged was 57 to 72 points  
(mean 64 points). Second group included 56 patients (49 male and 7 female), who underwent ACL  
reconstruction with double-bundle (DB) technique. Lachman test was positive in all patients of this group: 3-5  
mm (n=42), 6-10 mm (n=16). Anterior drawer test was negative in 8 patients, positive 3-5 mm (n=41), 6-10 mm  
(n=7). Pivot shift test was negative in 8 patients, positive 1+ (n=35), positive 2+ (n=13). A mean score on Lysholm  
scale ranged from 55 to 74 points (mean 62 points).  
The aim was to compare results of both techniques of ACL reconstruction that are made under spinal  
anesthesia in supine position of patient. Surgeries were performed by different doctors of the same department  
who were masters of arthroscopic surgery. An arthroscope is inserted inside of the knee with using routine  
anterolateral and anteromedial portals. First all knee structures is inspected carefully, including meniscus,  
articular cartilage, synovial membrane. In case of meniscus tear the torn part of meniscus is resected. Then ACL  
reconstruction is performed using single- or double-bundle technique depending on patient’s conditions,  
anatomy and individual parameters.  
Single-bundle technique of ACL reconstruction with lavsan tape  
After arthroscopically revealing ACL rupture the knee is flexed to 110о and a femoral tunnel is drilled at  
centre of insertion site of ACL using an anteromedial portal technique. First it is drilled with guide pin, then  
with drill diameter of 4 mm along the whole lateral condyle of the femur.  
After that knee flexed under 90о and the tip of the conductor is put to the insertion site of the centre of ACL.  
A conductor is placed on 45-50о to the articular surface of plateau of the tibia, approximately 3.5-4 cm medially  
from the tibial tuberosity. On this area an incision of 1.5 cm length is made. First it is drilled with a guide pin  
from this incision inside of the knee, and then the tunnel is drilled with a drill of 4 mm diameter. After drilling  
tunnels, first end of the lavsan tape of 5 mm width is passed first to the tibial and femoral tunnels respectively.  
The end of the lavsan tape is pulled out outside of lateral condyle of the femur, length of pulled out tape must be  
minimum 5 cm of length. Then 2 cm incision is made of medial condyle area, just near the insertion site of the  
medial collateral ligament to the femur. A surgical clamp is inserted from this incision between joint capsule  
and fascia, and directed distally, that is to the 1.5 mm sized incision on the anteromedial part of proximal tibia.  
Then the second end of the lavsan tape is fixed with a surgical clamp and pulled out from the incision on medial  
condyle of the femur.  
Citation: Irismetov ME, Usmonov FM, Shamshimetov DF, Kholikov AM, Rajabov KN, Tadjinazarov MB. 2019. Comparison of two methods of anterior cruciate  
ligament reconstruction with lavsan (polyethylene terephtalate). J Life Sci Biomed, 2019; 9(4): 109-116; www.jlsb.science-line.com  
110  
Drilling of transversal tunnel in the femur  
Then it is drilled a transversal tunnel with a guide wire  
from the medial condyle to the lateral condyle of the femur.  
After that it is drilled with 4 mm drill of diameter. Second end  
of the lavsan is passed from the transversal tunnel (from  
medial the condyle to the lateral condyle) and pulled out on  
the lateral femoral condyle area. Length of the free end of the  
lavsan tape must have 5 cm from a skin. The scheme of  
surgery is prescribed on figure 1.  
After pulling out of both ends of lavsan tape, 3 cm sized  
incision is made above on lateral femoral condyle between  
both ends of the lavsan tape. Both ends are pulled out from  
this incision, soft tissues separated till the bone tissues and  
are tied into a knot (Figure 2). The extra ends of the lavsan  
tape above the knot are cut. Drainage of wounds is made,  
sutures is put. Aseptic bandages. MRI is made after surgery  
(Figures 3 and 4).  
Figure 1. The scheme of single bundle ACL reconstruction with lavsan tape.  
A
B
Figure 2. A) Pulling out of both ends of the lavsan tape from the same incision; B) Knotting of both ends of  
lavsan tapes.  
A
B
C
Figure 3. MRI of patient after surgery. A) tibial tunnel on the right tibia;B) femoral tunnel of the left femur;C)  
transversal tunnel of femur of left femur.  
Citation: Irismetov ME, Usmonov FM, Shamshimetov DF, Kholikov AM, Rajabov KN, Tadjinazarov MB. 2019. Comparison of two methods of anterior cruciate  
ligament reconstruction with lavsan (polyethylene terephtalate). J Life Sci Biomed, 2019; 9(4): 109-116; www.jlsb.science-line.com  
111  
Figure 4. MRI of patient in 18 month after single-  
bundle ACL reconstruction technique. It is seen a  
ligamentization of the lavsan tape (yellow arrow) and a hole  
of the transversal tunnel in the femur (white arrow).  
Figure 5. Arthroscopic view of drilled femoral  
tunnels. AM: anteromedial tunnel, PM: posterolateral  
tunnel.  
Double-bundle technique of ACL reconstruction with lavsan tape  
The same arthroscopic portals are used for double-bundle technique. After arthroscopically revealing of  
ACL rupture the knee is flexed to 110о and two femoral tunnels is drilled at insertion sites of both bundles of  
ACL. First tunnel is drilled at insertion site of PL (posterolateral) bundle of ACL. It is drilled with guide pin first,  
then with drill diameter of 4 mm along the whole lateral condyle of the femur. In order to make the second  
tunnel a drill bit put to the insertion site of AM (anteromedial) bundle and it is drilled with guide pin first, then  
with drill diameter of 4 mm along the whole lateral condyle of the femur (Figure 5). After that knee flexed under  
90о and the tip of the conductor is put to the insertion site of PL bunble of ACL at tibia. Conductor is placed on  
45-50о to the articular surface of plateau of the tibia, approximately 3.0-4 cm medially from the tibial tuberosity.  
It is drilled with guide pin first, then with drill diameter of 4 mm from outside to inside (tunnel 3). Then the tip  
of the conductor is put to the insertion site of AM bunble of ACL at tibia. The conductor is placed on 60-65о to  
the articular surface of plateau of the tibia, approximately 1.5-2 cm medially from the tibial tuberosity.It is  
drilled with guide pin first, then with drill diameter of 4 mm from outside to inside (tunnel 4). After drilling  
tunnels, one end of the lavsan tape of 5 mm width is inserted first to the tunnel 3 (PL tunnel of tibia), then  
tunnel 1 1-tunnel (PL tunnel of femur) respectively. End of the lavsan tape is pulled out outside with minimum 5  
cm length on lateral condyle of femur. Second end of the lavsan tape is inserted first tunnel 4 and tunnel 2  
respectively (AM tunnels of tibia and femur respectively), then this second end is pulled out on the lateral  
condyle of femur with minimum 5 cm length on lateral condyle of femur. After pulling out of lavsan tapes 3.0  
cm sized incision is made above on lateral femoral condyle (the scheme of double-bundle-technique is  
prescribed on figure 6). Both ends of the lavsan tape are pulled out from this incision and tied into a knot  
(Figure 2). The extra ends of the lavsan tape above the knot are cut. Drainage of wounds is made, sutures is put.  
Aseptic bandages. With this way AM and PL bundles of ACL is created with a lavsan tape (Figure 7). MRI is done  
after surgery (Figure 8).  
Figure 6.Scheme of double-bundle ACL reconstruction. 1)  
PL tunnel in the femur, 2) AMtunnel in the femur, 3) PL  
tunnel in the tibia, 4) AM tunnel in the tibia.  
Figure 7. Arthroscopic view after double-bundle ACL  
reconstruction with lavsan tape. AM: anteromedial  
bundle, PL: posterolateral bundle.  
Citation: Irismetov ME, Usmonov FM, Shamshimetov DF, Kholikov AM, Rajabov KN, Tadjinazarov MB. 2019. Comparison of two methods of anterior cruciate  
ligament reconstruction with lavsan (polyethylene terephtalate). J Life Sci Biomed, 2019; 9(4): 109-116; www.jlsb.science-line.com  
112  
A
B
C
Figure 8. MRI of patient with double-bundle technique in 1 year after surgery. A) drilled femoral tunnels (yellow  
arrows). B, C). Ligamentization of lavsan tape is seen (white arrow).  
Postoperative treatment  
Postoperative treatment is done by a standard management of ACL reconstructed patients. Plaster cast  
was put to the operated extremity for 10-12 days period. In order to prevent hemathrosis and swelling ice packs  
were put regularly 10-15 minutes per hour to operated knees up to 10-12 days. From the next day of surgery  
isometric exercises of the knee were recommended to prevent hypotrophy of muscles. Medications (antibiotics,  
anticoagulants, anti-inflammation remedies and etc.) are recommended following standards of treatment.  
Walking was permitted from the next day of surgery with crutches till 4 weeks. In 10-12 days plaster cast is  
removed and passive range of motions in the knee (flexion, extension) are recommended. Strengthening  
exercises of quadriceps muscle are recommended step by step. Return to sport is recommended from 6-9  
month after surgery, depending on condition of patients.  
Ethical approval  
The review board and ethics committee of Republican Spezialized Scientific and Practical Medical Centre  
of Traumatology and Orthopaedics Uzbekistan approved the study protocol and informed consents were taken  
from all the participants.  
RESULTS  
All patients were followed up at 14-18 month period. At follow up period all patients of both group felt the state  
of their knees to become better. No major complications occurred as well as venous thrombosis, pulmonary  
embolism, intra-articular infection in both groups. Lachman, anterior drawer and pivot-shift tests were checked  
at follow up and patients accessed with Lysholm score. Concerning results of antero-posterior stability results  
were better in group 2. Lysholm score was higher in group 2 in compared to group 1. Concerning of pivot shift  
test better results achieved in group 2.  
Group 1. Lachman test was negative in 39 patients, slightly positive up to 3 mm in 7 patients. Anterior  
drawer test was negative in 42 patients and slightly positive up to 3 mm in 4 patients. Pivot-shift test was  
negative in 39 patients, slightly positive 1+ in 7 patients. A mean Lysholm score was grown up to 82 (ranged  
between 74 to 92).  
Group 2. Lachman test was negative in 50 patients, slightly positive up to 3 mm in 6 patients. Anterior  
drawer test was negative in 53 patients and slightly positive up to 3 mm in 3 patients. Pivot-shift test was  
negative in all 56 patients. A mean Lysholm score was grown up to 90 (ranged between 86 to 94).  
Patients with of 1-group had difficulty with increasing of motions of the knee. 7 patients of the 1-group had  
knee flexion deficit approximately 15-20о, while 2 patient of 2-group had knee flexion deficit who has  
osteoarthritic changes (Figure 9). Synovitis occurred in 6 patients (3 patients from group 1, 3 patients from  
group 2) till 2-3 months period after surgery. Synovitis was successfully treated with anti-inflammation  
remedies, ice packs, antibiotics, and intra-articular glucocorticosteroids.  
Citation: Irismetov ME, Usmonov FM, Shamshimetov DF, Kholikov AM, Rajabov KN, Tadjinazarov MB. 2019. Comparison of two methods of anterior cruciate  
ligament reconstruction with lavsan (polyethylene terephtalate). J Life Sci Biomed, 2019; 9(4): 109-116; www.jlsb.science-line.com  
113  
Table 1. Results of treatment of ACL reconstruction of both groups  
Lachman test  
Anterior drawer test  
Pivot shift test  
Groups  
Group 1  
3-5  
mm  
6-10  
mm  
3-5  
mm  
6-10  
mm  
Negative  
Negative  
Negative  
+
20  
7
++  
8
Preop:  
Before surgery  
Postop:  
-
32  
14  
-
4
42  
8
32  
4
10  
-
18  
39  
8
39  
-
7
39  
6
-
After surgery  
Preop:  
Before surgery  
Postop:  
17  
-
41  
3
7
35  
-
13  
-
Group 2  
50  
53  
-
56  
After surgery  
A
B
Figure 9. Range of motions after surgery. A) Patient in 18 motnth after singe- boundle ACL reconstruction with  
lavsan. There is knee flexion deficit for 20 dg. B) Patient in 12 month after double- boundle lavsanoplasty. No  
restriction of range of motions.  
DISCUSSION  
Many studies showed that results of ACL reconstruction with artificial ligaments were successful [3, 15-17].  
Krudwig [12] reported about good results in patients with their satisfaction and anteroposterior stability in  
patients with artificial Trevira-Hofest devices. Lavoi et al. [18] reported about good clinical results with using  
LARS artificial ligament at 8-45 follow up in 47 patients. But there are many reports about complications of  
artificial ligament (tear, foreign-body reactions, synovitis, recurrent instability) [11, 19, 20-22]. Gao et al. [23]  
reported about developed only one case of synovitis (from 159 patients) with overall complications rate 5,7%  
after ACL reconstruction with LARS in his a multicenter study in with 3- to 5-year follow up.  
In our study we watched synovitis in a few patients, who were prescribed medications and ice packages, in  
severe synovitis we used puncture of the operated knee with administering glucocorticosteroids. Our patients  
of 1-group felt pain and difficulties during active flexion of operated knee, especially flexion after 90 dg. It is  
explained with a non-anatomical position of the second end of lavsan tape. Perhaps, direction of the second end  
of a lavsan tape carried from the medial part of proximal tibia and its transversal direction from the medial  
condyle to the lateral condyle bothered to achieve full range of motion of the knee.  
Citation: Irismetov ME, Usmonov FM, Shamshimetov DF, Kholikov AM, Rajabov KN, Tadjinazarov MB. 2019. Comparison of two methods of anterior cruciate  
ligament reconstruction with lavsan (polyethylene terephtalate). J Life Sci Biomed, 2019; 9(4): 109-116; www.jlsb.science-line.com  
114  
Struewer et al. [17] and Lee et al. [24] reported about synovial coverage of grafts during second look  
arthroscopy after ACL reconstruction with augmentation with an artificial ligament. Despite we did not  
perform second look arthroscopy we watched a ligamentization of artificial grafts in MRI made after at least a  
year after surgery in both methods.  
It is necessary to take into account details, which depends also on human factor. There are two problems  
which affects the functional outcome of primary ACL reconstruction. First is a correct femoral and tibial tunnel  
placement. If drill the tunnel too anteriorly on the femoral condyle it may lead to reduced knee flexion and  
instability of the knee. If drill the tunnel too posteriorly on the lateral femoral condyle it may lead to reduced  
extension.  
Second is a persisting instability after single-bundle ACL reconstruction [1]. ACL reconstruction focused  
only AM bundle reconstruction ignoring PL bundle leads to rotational instability. It is necessary to take  
attention that pivot-shift test is not objective but subjective assessment, it is done manually. The speed of the  
procedure, a magnitude of force applied to the knee and the abduction angle of the hip depends on examiner  
[25]. Several studies showed that there are not significant differences of results between single-and double-  
bundle technique when the graft placed anatomically [7, 8].  
CONCLUSION  
Our study showed that double-bundle reconstruction of ACL with lavsan provided better results than single-  
bundle technique. It was seen especially in rotational stability. Besides that there were not problems of double-  
bundle group with restricting of range of motions of operated knee. In choose ACL reconstruction technique it  
is necessary to take into account anatomic features and changes of the knee. Thus, on method of ACL  
reconstruction: single-bundle or double-bundle technique, surgery should be performed according an anatomic  
double-bundle structure of ACL.  
DECLARATIONS  
Acknowledgements  
This work was supported by, Republican Spezialized Scientific and Practical Medical Centre of  
Traumatology and Orthopaedics Uzbekistan, Tashkent, Uzbekistan  
Authors’ Contributions  
All authors contributed equally to this work.  
Competing interests  
The authors declare that they have no competing interests.  
REFERENCES  
1. Zhu W, Lu W, Han Y, Hui S, Ou Y, Peng L, Fen W, Wang D, Zhang L, Zeng Y. Application of a computerised navigation  
technique to assist arthroscopic anterior cruciate ligament reconstruction. International Orthopaedics. 2013 Feb  
1;37(2):233-8. (Search Google Scholar ; Export Citation as EndNote)  
2. Muller B, Hofbauer M, Wongcharoenwatana J, Fu FH. Indications and contraindications for double-bundle ACL  
reconstruction. International Orthopaedics. 2013 Feb 1;37(2):239-46. (Search Google Scholar  
EndNote)  
; Export Citation as  
3. Machotka Z, Scarborough I, Duncan W, Kumar S, Perraton L. Anterior cruciate ligament repair with LARS (ligament  
advanced reinforcement system): a systematic review. BMC Sports Science, Medicine and Rehabilitation. 2010 Dec;  
2(1):29. doi: 10.1186/1758-2555-2-29. (Search Google Scholar ; Export Citation as EndNote)  
4. Siebold R, Dehler C, Ellert T. Prospective randomized comparison of double-bundle versus single-bundle anterior  
cruciate ligament reconstruction. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2008 Feb 1;24(2):137-45.  
(Search Google Scholar ; Export Citation as )  
5. Zaffagnini S, Bruni D, Muccioli GM, Bonanzinga T, Lopomo N, Bignozzi S, Marcacci M. Single-bundle patellar tendon  
versus non-anatomical double-bundle hamstrings ACL reconstruction: a prospective randomized study at 8-year  
minimum follow-up. Knee Surgery, Sports Traumatology, Arthroscopy. 2011 Mar 1;19(3):390-7. 19:390-397. (Search  
Google Scholar ; Export Citation as EndNote)  
Citation: Irismetov ME, Usmonov FM, Shamshimetov DF, Kholikov AM, Rajabov KN, Tadjinazarov MB. 2019. Comparison of two methods of anterior cruciate  
ligament reconstruction with lavsan (polyethylene terephtalate). J Life Sci Biomed, 2019; 9(4): 109-116; www.jlsb.science-line.com  
115  
6. Streich NA, Friedrich K, Gotterbarm T, Schmitt H. Reconstruction of the ACL with a semitendinosus tendon graft: a  
prospective randomized single blinded comparison of double-bundle versus single-bundle technique in male athletes.  
Knee Surgery, Sports Traumatology, Arthroscopy. 2008 Mar 1;16(3):232-8. (Search Google Scholar ; Export Citation as  
EndNote)  
7. Hussein M, van Eck CF, Cretnik A, Dinevski D, Fu FH. Prospective randomized clinical evaluation of conventional  
single-bundle, anatomic single-bundle, and anatomic double-bundle anterior cruciate ligament reconstruction: 281  
cases with 3-to 5-year follow-up. Am J Sports Med, 2012 Mar;40(3):512-20. (Search Google Scholar ; Export Citation as  
EndNote)  
8. Hussein M, van Eck CF, Cretnik A, Dinevski D, Fu FH. Individualized anterior cruciate ligament surgery: a prospective  
study comparing anatomic single-and double-bundle reconstruction. Am J Sports Med, 2012 Aug;40(8):1781-8. (Search  
Google Scholar ; Export Citation as EndNote)  
9. Li X, Xu CP, Song JQ, Jiang N, Yu B. Single-bundle versus double-bundle anterior cruciate ligament reconstruction: an  
up-to-date meta-analysis. International orthopaedics. 2013 Feb 1;37(2):213-26. (Search Google Scholar ; Export Citation  
as EndNote)  
10. Newman SD, Atkinson HD, Willis-Owen CA. Anterior cruciate ligament reconstruction with the ligament augmentation  
and reconstruction system: a systematic review. Int Orthop. 2013 Feb;37(2):321-6. doi: 10.1007/s00264-012-1654-y. Epub  
2012 Sep 14. (PubMed PMID: 22976593; PubMed Central PMCID: PMC3560896 ; Export Citation as RIS)  
11. Boszotta H, Helperstorfer W, Pflanzl W. Foreign body synovitis--a limiting factor in use of the Trevira ligament in  
cruciate ligament surgery?. Unfallchirurgie. 1993 Jun; 19(3):138-43. (Search Google Scholar  
EndNote)  
; Export Citation as  
12. Krudwig WK. Anterior cruciate ligament reconstruction using an alloplastic ligament of polyethylene terephthalate  
(PET–Trevira®–hochfest). Follow‐up study. Biomed Mater Eng, 2002 Jan 1;12(1):59-67. (Search Google Scholar ; Export  
Citation as EndNote)  
13. Huang JM, Qian WA, Feng SH, Wang ZM, Kang YF. Cruciate ligament reconstruction using LARS artificial ligament  
under arthroscopy: 81 cases report. Chinese Med J. 2010 Jan 1;123(2):160-4. (Search Google Scholar ; Export Citation as  
EndNote)  
14. Parchi PD, Ciapini G, Paglialunga C, Giuntoli M, Picece C, Chiellini F, Lisanti M, Scaglione M. Anterior cruciate ligament  
reconstruction with LARS artificial ligament—clinical results after a long-term follow-up. Joints. 2018 Jun; 6(02):075-9.  
6(2):75-79. (Search Google Scholar ; Export Citation as EndNote)  
15. Pan X, Wen H, Wang L, Ge T. Bone–patellar tendon–bone autograft versus LARS artificial ligament for anterior cruciate  
ligament reconstruction. Eur J Orthop Surg Traumatol, 2013 Oct 1;23(7):819-23. (Search Google Scholar  
Citation as EndNote)  
; Export  
16. Nau T, Lavoie P, Duval N. A new generation of artificial ligaments in reconstruction of the anterior cruciate ligament:  
two-year follow-up of a randomised trial. J Bone Joint Surg Br, 2002 Apr;84(3):356-60. (Search Google Scholar ; Export  
Citation as EndNote)  
17. Struewer J, Ziring E, Ishaque B, Efe T, Schwarting T, Buecking B, Schüttler KF, Ruchholtz S, Frangen TM. Second-look  
arthroscopic findings and clinical results after polyethylene terephthalate augmented anterior cruciate ligament  
reconstruction. International orthopaedics. 2013 Feb 1;37(2):327-35. (Search Google Scholar ; Export Citation as  
EndNote)  
18. Lavoie P, Fletcher J, Duval N. Patient satisfaction needs as related to knee stability and objective findings after ACL  
reconstruction using the LARS artificial ligament. The knee. 2000 Jul 1;7(3):157-63. (Search Google Scholar ; Export  
Citation as EndNote)  
19. Barrett GR, Line JR LL, Shelton WR, Manning JO, Phelps R. The Dacron ligament prosthesis in anterior cruciate  
ligament reconstruction: A four-year review. Am J Sports Med, 1993 May;21(3):367-73. (Search Google Scholar ; Export  
Citation as EndNote)  
20. Ventura A, Terzaghi C, Legnani C, Borgo E, Albisetti W. Synthetic grafts for anterior cruciate ligament rupture: 19-year  
outcome study. The Knee. 2010 Mar 1;17(2):108-13. (Search Google Scholar ; Export Citation as EndNote)  
21. Olson EJ, Kang JD, Fu FH, Georgescu HI, Mason GC, Evans CH. The biochemical and histological effects of artificial  
ligament wear particles: in vitro and in vivo studies. Am J Sports Med, 1988 Nov;16(6):558-70. (Search Google Scholar ;  
Export Citation as EndNote)  
22. Ishibashi Y, Toh S, Okamura Y, Sasaki T, Kusumi T. Graft incorporation within the tibial bone tunnel after anterior  
cruciate ligament reconstruction with bone-patellar tendon-bone autograft. Am J Sports Med, 2001 Jul;29(4):473-9.  
(Search Google Scholar ; Export Citation as EndNote)  
23. Gao K, Chen S, Wang L, Zhang W, Kang Y, Dong Q, Zhou H, Li L. Anterior cruciate ligament reconstruction with LARS  
artificial ligament: a multicenter study with 3-to 5-year follow-up. Arthroscopy: The Journal of Arthroscopic & Related  
Surgery. 2010 Apr 1;26(4):515-23. (Search Google Scholar ; Export Citation as EndNote)  
24. Lee JH, Bae DK, Song SJ, Cho SM, Yoon KH. Comparison of clinical results and second-look arthroscopy findings after  
arthroscopic anterior cruciate ligament reconstruction using 3 different types of grafts. Arthroscopy: The Journal of  
Arthroscopic & Related Surgery. 2010 Jan 1;26(1):41-9. (Search Google Scholar ; Export Citation as EndNote)  
25. Legnani C, Ventura A, Terzaghi C, Borgo E, Albisetti W. Anterior cruciate ligament reconstruction with synthetic grafts.  
A review of literature. International Orthopaedics. 2010 Apr 1;34(4):465-71. (Search Google Scholar ; Export Citation as  
EndNote)  
Citation: Irismetov ME, Usmonov FM, Shamshimetov DF, Kholikov AM, Rajabov KN, Tadjinazarov MB. 2019. Comparison of two methods of anterior cruciate  
ligament reconstruction with lavsan (polyethylene terephtalate). J Life Sci Biomed, 2019; 9(4): 109-116; www.jlsb.science-line.com  
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