Physical Education - Issues Analysis

Is LARS Surgery worth the Risk?

Introduction
Ligament Augmentation and Reconstructive System (LARS) surgery is currently the
quickest available
technique to return to sports after tearing your ACL. The surgery involves using a
ligament created from
industrial-strength polyester fibres (PETP or polyethylene terephthalate) to replace
the torn ACL. This
procedure has cut the recovery time by one third. During the procedure, the ends of
the ruptured ACL
are sutured together and the synthetic ligament is passed through the middle of the
ACL. The surgery
has not gone without some criticism from surgeons; these include Surgeon
XXXXXXXXXX and Orthopaedic Surgeon XXXXXXXXXX.
LARS surgery is a number of synthetic ligament devices available to a range of
applications from
Posterior Cruciate and Anterior Cruciate reconstructions in the knee to Achilles
tendon and AcromioClavicular repairs. The surgery was designed to take the place of the normal
anatomic ligament
fibres. The intra-articular longitudinal fibres resist fatigue and allow fibroblastic in
growth. The extra-articular woven fibres provide strength and resistance to
elongation.
Pros
The traditional knee reconstruction is a full reconstruction of the anterior cruciate
ligament which
takes a minimum of twelve months recovery. LARS surgery involves using a
synthetic ligament to
take the place of the original ligament; the recovery time can be as little as 10
weeks. There are
many advantages to having LARS surgery but the major benefit is the rapid time it
takes to come
back to playing. See figure 1 for facts on the surgery.

Critical Analysis and

Evaluation
Some critical analysis
and evaluation of an
issue related to
physical activity that
has some relevance to
local, regional, national
or global communities.

Figure 1
Less Pain - 90% of patients feel no pain postoperatively
Less Swelling - 95% of patients have no swelling or light swelling tendencies
postoperatively
Less Restrictions - 86% of patients have no minimal restrictions
postoperatively.
http://www.Iars-ligaments.com/- 2008 LARS SA. Site visited on 21/3/2011
Cons
The main risk with having the LARS surgery is the reliability of the synthetic strand
and how long before
the strand will rupture. This shows that the although there is a short-term gain in
having less time
sidelined, you run the risk of eventually spending more time of the pitch because
you need another
reconstruction. According to Orthopaedic surgeon XXXXXXXXXX, players who
choose the LARS
surgery option, run the risks of not only rupturing the tendon but also early arthritis.

Page 1 of 7

Knowledge and
Understanding
Competent knowledge
and understanding of
appropriate
terminology.

Stage 2 Physical Education issues analysis response

Ref: A196430 (revised August 2012)
SACE Board of South Australia 2012

 http://physiosolutions.blogspot.com/2011/01/lars-for-acl-reconstruction.html Physio
Solutions. Site visited
30/5/2011)
http://www.lars-ligaments.coml. - 2008 LARS SA. Site visited on 21/3/2011
http://www.lars-ligaments.com/ - 2008 LARS SA. Site visited on 21/3/2011
htto://wwwlars-ligaments.com/ - 2008 LARS SA. Site visited on 21/3/2011
http://www.heraldsun.com.au/sport/afl/what-are-we-waiting-for/story-e6fri9ox1225717653527 - Herald
and Weekly Times, site visited 25/9/2011.

Page 2 of 7

Stage 2 Physical Education issues analysis response

Ref: A196430 (revised January 2013)
SACE Board of South Australia 2012

Due to the amount of scrutiny and fears the synthetic implant has, the surgery has
been banned in
the USA and France by the medical authorities due to the amount of post-operative
swelling in the
joint.
Popularity amongst AFL players
In February of 2008, Nick Malceski was the first Australian football player to use the
new
controversial technique; Malceski was back playing for Sydney Swans 86 days later.
In March of
2011, Malceski was forced to undergo surgery on the same knee, but not without
some criticism.
Malceski put the rumours to rest when he returned only 76 days after the surgery to
play for the
Sydney Swans. A total of seven players in the AFL system have undergone LARS
surgery (as seen in
Appendix 1) with two of these players forced to undergo the surgery again.
Opinions on LARS surgery
After David Rodan reinjured his left knee in late November of 2010, he again chose
the LARS surgery
option. David's opinion on the surgery is very strong, saying "I'm very confident I
can come back and do
it all again." David's clear and strong opinion on the surgery shows that he believes
the pros outweigh
the cons; this is because the recovery time from the LARS surgery allowed him to
return to play much
early then if he underwent the traditional pathway.

Critical Analysis and

Evaluation
Mostly focused use of
information from
different sources with
appropriate
acknowledgment.

After the post boy for LARS surgery 'Nick Malceski' reinjured the same knee as he
had the surgery
on, there were many questions asked the reliability and trustworthiness of LARS
surgery. Sydney
club doctor Nathan Gibbs backed Malceski's decision to undergo LARS a second
time, saying "the
option was available to us with this revision reconstruction, to use the conventional
method or LARS
surgery, and Nick was very keen to pursue the LARS surgery."
According to Brad Fisher, an ex-Australian footballer who has undergone the surgery
whilst playing
for Carlton FC, LARS surgery might not be the best option for a young player due to
unreliability of the
surgery and that the player eventually could spend more time on the side line if
they take the LARS
surgery option. Although Fisher is not an expert within this field of medical
knowledge, his views on
LARS surgery would be valid due to his experience with artificial tendons.

Knowledge and
Understanding
Competent knowledge
and understanding of
appropriate
terminology.

Surgeon XXXXXXXXXX was asked his opinion on the surgery by the Collingwood
Football Club
regarding the LARS surgery option. He responded by saying 'I strongly recommend
not undergo the
LARS option, due to its reliability.' XXXXXXXXXX opinion on the Surgery is clear to
see and his
professional view on the surgery is that the cons outweigh the pros.
Orthopaedic Surgeon XXXXXXXXXX has warned that there is no knee operation
available better

Page 3 of 7

Stage 2 Physical Education issues analysis response

Ref: A196430 (revised January 2013)
SACE Board of South Australia 2012

than the conventional approach. XXXXXXXXXX said 'that the rate of post-operative
synovitis (joint inflammation) in the new technique was so high that all synthetic
grafts for knee reconstructions are
banned in France 'and also said 'he is very concerned for Malceski's future.'

http://www.heraldsun.com.au/sport/afl/take-two-as-david-rodan-aoain-takes-the-radicalroad/story-e6frf9jf1226008477594 - Herald and Weekly Times. Site visited 26/8/2011

http://www.theaustralian.com.au/news/sport/not-evervone-is-convinced-about-lars-kneereconstruction-afternickmalceskibreaks-down/story-e6frg7mf-1226015631367 - 2011 News Limited. Site visited 26/8/2011
Fisher 2011. pers.comm. April
http://www.thesportsphysiotherapist.com/acl-reconstruction-with-the-lars-ligament/ - 2011
The Sports
Physiotherapist. Site Visited 26/8/2011
http://www.heraldsun.com.au/sport/afl/what-are-we-waiting-for/story-e6frf9ox1225717653527 Herald and Weekly Times, site visited 25/9/2011.

Page 4 of 7

Stage 2 Physical Education issues analysis response

Ref: A196430 (revised January 2013)
SACE Board of South Australia 2012

Conclusion
Through the research I have completed, I believe that LARS surgery is not the best
option even with
the dramatic and rapid recovery time that LARS surgery has. In the AFL there seems
to be an
overwhelming favouritism towards LARS surgery if the option is there, but I do
believe to this day there
is still not enough research and development in the LARS brand and surgery, I
would recommend the
traditional surgery path because it is a much safer and overtime a more successful
option with fewer
risks.
Bibliography
http://www.smh.com.au/afl/afl-news/sydnev-out-their-faith-in-miracle-man-malceski201105191evOn.html - 2011 Fairfax Media. Site visited 25/5/2011
http://www.heraldsun.com.au/sport/afl/xavier-clarkes-career-still-alive-after-lars-kneesurgerv/
story-e6frf9if-1225994768182 - Herald and Weekly Times. Site visited 25/5/2011

Critical Analysis and

Evaluation
Some critical analysis
and evaluation of a
related to physical
activity that has some
relevance to local,
regional, national or
global communities.

Critical Analysis and

Evaluation
Mostly focused use of
information from
different sources with
appropriate
acknowledgment.

htto://www.heraldsun.com.au/sbort/afl/brent-staker-has-successful-lars-kneeoperation/storye6frf9if1226030657926 - Herald and Weekly Times. Site visited 25/5/2011

http://www.theaustralian.com.au/news/sport/not-everyone-is-convinced-about-larskneereconstructionafter-nick-malceski-breaks-down/stoty-e6frOmf-1226015631367 -10 2011 News
Limited. Site visited 25/5/2011
http://www.abc.net.au/news/stories/2010J04/25/2882179.htm - 2011 ABC. Site visited
25/5/2011
http://www.adelaidenow.com.au/sbort/afl/brett-ebert-ponders-la rs-surgery/story-e6freco31225908735051 - 2011 News Limited. Site visited 25/5/2011
http://www.heraldsun.com.au/sbort/afl/lion-josh-drummond-hobes-to-return-thisyear/storye6frf9if1225865138355 - Herald and Weekly Times. Site visited 25/5/2011
http://www.sportsnewsfirst.com.au/articles/2011/03/03/rnalceski-needs-second-larsoperation/ 2011 Sports News First. Site visited 13/9/2011

Word count: 999

Response 1 Additional comments
Introduction displays:

appropriate use of terminology

information provided about the issue without discussion of the reason for it being an issue.

Possible considerations for further development of the response:

further in-depth investigation and analysis of the pros/cons of the procedure

specific factual evidence about the popularity of the procedure

focus on evidence and issues of reliability, longevity and future related problems in addition to the
appropriate use of a variety of opinions.

Referencing displays:

generally a thorough range of information sources accessed, mostly confined to AFL websites.
Note: Care should be taken with specific topic selection and wording. In this response the outline of the issue is
very general in nature while the discussion is generally confined to AFL circumstances.
Page 5 of 7

Stage 2 Physical Education issues analysis response

Ref: A196430 (revised January 2013)
SACE Board of South Australia 2012

Physical Education - Issues Analysis

Appendix

Appendix 1

February 2008, Nick Malceski from Sydney Swans was the first Australian footballer to
undergo LARS surgery option

December 2009, David Rodan from Port Adelaide injured his left knee and opted for
LARS

February 2010, Brad Fisher, an ex Carlton player, injured his right knee and
underwent LARS surgery to try and save his career

May 2010, Josh Drummond from Brisbane Lions also choose the LARS surgery option

August 2010, Brett Ebert from Port Adelaide opted for LARS surgery also

November 2010, David Rodan reinjured his left knee which he had surgery on 11
months earlier and had to undergo the LARS surgery again

January 2011, Xavier Clarke from Brisbane Lions injured his right knee and was
forced to choose the LARS surgery option to also salvage his career

3rd of March 2011, Nick Malceski underwent LARS surgery again

30th of March 2011, Brent Staker from Brisbane Lions injured his right knee and had
choose to undergo the LARS surgery option

Page 6 of 7

Stage 2 Physical Education issues analysis response

Ref: A196430 (revised January 2013)
SACE Board of South Australia 2012

Performance Standards for Stage 2 Physical Education

Knowledge and
Understanding

In-depth knowledge, informed

understanding and accurate
application of physical education
concepts relevant to specific
physical activities.
In-depth knowledge and
understanding of exercise
physiology, the biomechanics of
human movement, and skills
acquisition.

Practical Skills
Application
A high level of proficiency in the
performance of physical activities,
with reference to specific skills
criteria.
Accurate interpretation and
proactive application of skills,
specific concepts, ideas,
strategies, and techniques, in a
practical context.

Initiative and
Collaboration
A proactive approach to
demonstrating initiative,
self-reliance, and
leadership in practical
activities.
Constructive and confident
interpersonal and
collaborative skills in team
situations.

Well-considered knowledge,
informed understanding and
application of physical education
concepts relevant to specific
physical activities.
Some depth of knowledge and
understanding of exercise
physiology, the biomechanics of
human movement, and skills
acquisition.

Proficiency in the performance of

physical activities, with reference
to specific skills criteria.
Capable interpretation and active
application of skills, specific
concepts, ideas, strategies, and
techniques, in a practical context.

An active approach to
demonstrating initiative,
self-reliance, and
leadership in practical
activities.
Confident interpersonal
and collaborative skills in
team situations.

Considered knowledge, informed

understanding and competent
application of physical education
concepts relevant to specific
physical activities.
Considered knowledge and
understanding of exercise
physiology, the biomechanics of
human movement, and skills
acquisition.

Competent performance in
physical activities, with reference
to specific skills criteria.
Competent interpretation and
application of skills, specific
concepts, ideas, strategies, and
techniques, in a practical context.

Generally effective
demonstration of initiative
and self-reliance, and
some contribution to
leadership in practical
activities.
Appropriate interpersonal
and collaborative skills in
team situations.

Competent knowledge and

understanding of appropriate
terminology.

Recognition and some

understanding and application of
physical education concepts
relevant to one or more specific
physical activities.
Some recognition and
understanding of aspects of
exercise physiology, the
biomechanics of human movement,
and/or skills acquisition.

Some competence in aspects of

the performance of physical
activities, with reference to
specific skills criteria.

Occasional demonstration
of initiative and selfreliance in practical
activities, with support.

Inconsistent interpretation and

application of skills, specific
concepts, or ideas, in a practical
context.

Occasional demonstration
of collaborative skills in
team situations, with some
use of interpersonal skills.

Limited performance in one or

more physical activities, with
reference to specific skills criteria.

Limited awareness of aspects of

exercise physiology, the
biomechanics of human movement,
or skills acquisition.

Emerging ability to interpret or

apply skills, specific concepts, or
ideas, in a practical context.

Page 7 of 7

Detailed critical analysis of practical

techniques and performance.
Logical evaluation of the relevance of
principles and concepts to a given
situation.
Critical analysis and evaluation of an
issue related to physical activity and
relevant to local, regional, national, or
global communities.

Some critical analysis of practical

techniques and performance, with a
tendency to rely on description.
Generally clear evaluation of the
relevance of principles and concepts to a
given situation.
Some critical analysis and evaluation of
an issue related to physical activity that
has some relevance to local, regional,
national, or global communities.

Some consideration and basic description

of a narrow range of practical techniques
and performance.
Some consideration of the relevance of
principles and concepts to a given
situation.
Basic description of some aspects of an
issue related to physical activity but with
limited relevance to local, regional,
national, or global communities.
Some use of information from more than
one source, with attempted
acknowledgment.

Limited awareness and application

of one or more physical education
concepts.

Limited awareness of basic

terminology that may be
appropriate.

Perceptive and critical analysis and

evaluation of an issue related to physical
activity and clearly relevant to local,
regional, national, or global communities.

Competent use of information from

different sources, with appropriate
acknowledgment.

Some recognition and

understanding of basic terminology
that may be appropriate.

Highly discerning evaluation of the

relevance of principles and concepts to a
given situation.

Mostly focused use of information from

different sources, with appropriate
acknowledgment.

Mostly clear knowledge and

understanding of appropriate
terminology.

Thorough and insightful critical analysis of

practical techniques and performance.

Thorough and focused use of information

from different sources, with appropriate
acknowledgment.

Clear and accurate knowledge and

understanding of appropriate
terminology.

Critical Analysis and

Evaluation

Some recognition of the

need for initiative, selfreliance, or leadership in
practical activities.
Emerging collaborative
skills in team situations,
with limited use of
interpersonal skills.

Identification and some limited description

of one or more practical techniques or
performance.
Recognition of the need to consider the
relevance of principles and concepts for a
given situation.
Disconnected description of an issue
related to physical activity.
Attempted use of information from a
source, with limited acknowledgment.

Stage 2 Physical Education issues analysis response

Ref: A196430 (revised January 2013)
SACE Board of South Australia 2012