{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:21:46Z","timestamp":1783488106560,"version":"3.55.0"},"reference-count":33,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T00:00:00Z","timestamp":1754352000000},"content-version":"vor","delay-in-days":35,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate mid\u2010term clinical outcomes and intraoperative findings in patients undergoing single\u2010stage revision after failed ligament advanced reinforcement system (LARS) anterior cruciate ligament reconstruction (ACLR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study evaluated patients who underwent ACL revision surgery following initial reconstruction using the LARS device. Clinical assessments included the Tegner activity scale, Lysholm Knee score, and International Knee Documentation Committee (IKDC) scores, recorded preoperatively and at a minimum follow\u2010up of 5 years. Preoperative imaging was conducted to assess tunnel widening, alignment, and the presence of arthritic changes. Intraoperative evaluations included arthroscopic inspection of the synovium, menisci, and cartilage. Synovial biopsies were obtained for histological analysis of inflammation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty\u2010five patients were included in the study. Clinical scores demonstrated significant improvement in Tegner activity scale (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0006), Lysholm Knee score (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0001) and IKDC score (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0001) following revision surgery, with a mean follow\u2010up duration of 7.8 years (SD\u2009=\u20092.13). Preoperative imaging revealed early arthritic changes in 52% of patients. Intraoperative findings showed that all patients exhibited synovial membrane inflammation, with a 100% incidence of synovitis. Additionally, 68% of patients presented with Stage III or IV chondral lesions according to the ICRS classification.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Single\u2010stage revision ACLR using autografts led to significant clinical improvement after LARS ACLR failure, with a mean follow\u2010up of 7.8 years. All cases during revision demonstrated synovial inflammation, with a high prevalence of chondral lesions and early arthritis. While these findings may point to a potential association between synthetic grafts and degenerative joint pathology, causality cannot be established, as degenerative changes are known to occur following failed ACL reconstructions regardless of graft type.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level IV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70381","type":"journal-article","created":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T09:17:34Z","timestamp":1754385454000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Single\u2010stage autograft revision for failed ligament advanced reinforcement system (LARS) anterior cruciate ligament reconstruction: Improved clinical outcomes at a minimum 5\u2010year follow\u2010up"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7889-3829","authenticated-orcid":false,"given":"Vasileios S.","family":"Akrivos","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences University of Thessalia Larissa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonios","family":"Koutalos","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences University of Thessalia Larissa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Nastas","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences University of Thessalia Larissa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0368-0465","authenticated-orcid":false,"given":"Nifon","family":"Gkekas","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences University of Thessalia Larissa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pavlos","family":"Akritidis","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences University of Thessalia Larissa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelos","family":"Gatos","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences University of Thessalia Larissa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9494-6048","authenticated-orcid":false,"given":"Michael","family":"Hantes","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences University of Thessalia Larissa 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