Assessment Type 2: Folio Issues Analysis

For Anterior Cruciate Ligament (ACL) reconstruction, is the LARS ligament reconstruction the
pathway for athletes to undertake compared to the traditional procedure?

The ACL connects the front of the tibia to the back of the femur (Donohue unknown
date). The
traditional ACL reconstruction is divided into two procedures known as autograft or
allograft
reconstruction. They consist of grafting hamstring tissue from a patient or donor to

Knowledge and
Understanding
Clear and accurate
knowledge and
understanding of
appropriate
terminology.

replicate the original

ACL (Robert 2009). After 2 decades of research, the LARS ligament reconstruction
was developed in
France which primarily is structured to duplicate normal ligament fibres. It consists
of a Y shaped
synthetic polyester scaffold that attaches to the bone (Donohue unknown date). The
synthetic ligament
is made up of intraarticular and extraarticular woven fibres to promote fibroblastic
growth to provide
strength within the knee joint (LARS: Ligament Augmentation & Reconstruction
System 2011).
According to

, Sports Doctor, he states that the LARS ligament

reconstruction is becoming
more popular (refer to appendix 2). This is due to the fact that research has shown
that the LARS
reconstruction offers athletes the chance to return to the elite competition quicker
in comparison to the
traditional procedure (Korah unknown date). However is the LARS ligament suitable
for all forms of
competition or age groups?
Founded by research, the LARS reconstruction offers a shorter recovery in
comparison to the traditional
ACL procedure. According to Greenburg (2002), using the traditional procedure, the
athlete wouldnt be
able to return to competition between 1218 months. However using the LARS
ligament reconstruction

Critical Analysis and

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

it could cut the recovery time to 612 weeks. The traditional reconstruction
extensive rehabilitation is to
allow new tissue to grow over the inserted graft resulting in a stable knee. Whereas
the LARS ligament
reconstruction offers instant strength and movement as it is structured to replicate
the original ACL
Page 1 of 13

Stage 2 Physical Education issues analysis response

Ref: A196585 (revised January 2013)
SACE Board of South Australia 2012

(Muderis 2010). A survey was conducted which included 30 people of all ages that
play or dont play
sport about ACL reconstruction (refer to appendix 1). From the survey, 60% of
people had heard about
the LARS reconstruction and 73% would undertake this procedure despite a lack of
research on the long
term warranty as it presents a shorter recovery.
Athletic performance when returning to competition from ACL reconstruction varies
between the two
different procedures. Based on studies, 86% of patients who had the LARS Ligament
recorded minimal
restrictions and were able to undertake a full range of motion 3 weeks post surgery

Critical Analysis and

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

(Korah unknown
date). In comparison, the traditional reconstruction approximately allows patients to
restore near full
stability with a 90% chance of returning to normal competition level ( What Can I Expect
after My ACL

Reconstruction? 2004). A survey based on the traditional ACL reconstruction was

conducted between
seasons 1993 and 2005 of the NBA (National Basketball Association). The survey
concluded that out of
27 basketball players tested, 22% didnt return to NBA competition and 44%
decreased in performance
(Busfield 2009). In contrast, David Rodan, Port Adelaide midfielder, showed little
restriction in
performance post the LARS reconstruction due to evidence that he led Port
Adelaides Brownlow vote
count after the first 7 rounds. This was even after missing the first three rounds due
to rehabilitation
(Brownlow 2010: Votes 2010).

Page 2 of 13

Stage 2 Physical Education issues analysis response

Ref: A196585 (revised January 2013)
SACE Board of South Australia 2012

Since the LARS reconstruction is relatively new, the long term warranty of the
ligament is yet to be
found. According to Sanders (2008) the traditional ACL reconstruction should last
your whole life,
however depending on your level of physical activity the new ligament may tear.
, Sports Physician, metaphorically quotes that, The LARS is like a new set of
tires for a

Critical Analysis and

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

car. If you drive conservative then you will cover more distance. However if
you are hoon driving,
the tires will deteriorate and fail quicker (refer to appendix 3).
In March 2011, Nick Malceski, Sydney Swans defender, reinjured his LARS ligament
in his right leg which
required a second operation (Malceski set for more surgery 2011). As well Joseph
Costa, Adelaide
United midfielder, reinjured his LARS ligament however decided to undergo the

Critical Analysis and

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

traditional ACL
reconstruction for the second operation (Season over for Costa 2010).
recommends that elite
and young athletes should not undertake the LARS reconstruction. He sees it only
being used as a quick
fix for someone at their end of their career. Gbler (2006) produced a report
involving 26 patients of a
minimum 12 months that had received the LARS reconstruction. The research found
that 42% of the
patients needed a reoperation, 69% had complications and 15% had severe laxity at
the joint. In relation
to the traditional reconstruction, the American Academy of Orthopaedic Surgeons
found that patients
who undertook autograft reconstruction had a 4.3% failure chance (Sanders 2008).
From leading surgeons, they believe that the short recovery of the LARS
reconstruction could lead to
premature osteoarthritis. Osteoarthritis is the breakdown of cartilage that cushions
bones between

Knowledge and
Understanding
Clear and accurate
knowledge and
understanding of
appropriate
terminology.

joints. If osteoarthritis occurs, generally an artificial joint is required which only lasts
20 years
(Osteoarthritis unknown date). Dr Young quoted that osteoarthritis could occur as,
it takes 1216
weeks for the articular cartilage and joint fluid to return to normal after the initial
trauma and surgery

Page 3 of 13

Stage 2 Physical Education issues analysis response

Ref: A196585 (revised January 2013)
SACE Board of South Australia 2012

(Albergo 2010). Professor Leo Pinczewski constructed a 15 year follow up of the

traditional ACL
reconstruction and found long standing stable joints and low development of
osteoarthritis. However,
Professor Pinczewski believes the LARS treatment produces good 57 years support
but increases risk of
premature osteoarthritis surgery (Pinczewski 2010).
The LARS ligament reconstruction is one of many new advances in medical surgery
that is designed to
reduce rehabilitation from rupturing the ACL. Although the LARS reconstruction
reduces the athletes

Knowledge and
Understanding
Clear and accurate
knowledge and
understanding of
appropriate
terminology.

rehabilitation quite significantly less than the traditional method, sport physicians
and scientific surveys
indicate that the LARS ligament is not suitable for elite or young athletes. Studies
have evaluated that
the LARS reconstruction could only be used as a quick fix for older athletes who
are at the end of their
career. Sport Physicians strongly recommended that the traditional procedure is the
best option for
elite athletes who have ruptured their ACL. This is due to the fact that the LARS
ligament cant sustain
the strength needed at elite competition for long enough.
Word Count: 1000 words

Page 4 of 13

Stage 2 Physical Education issues analysis response

Ref: A196585 (revised January 2013)
SACE Board of South Australia 2012

Reference List
Albergo, L 2010, Surgeons Voice LARS Concerns, AFANA, accessed 21 October 2010,
<http://www.afana.com/drupal5/news/2010/08/11/surgeons_voice_lars_concerns
2178>
Brownlow 2010: Votes 2010, Port Adelaide Football Club, accessed 6 March 2011,
<http://www.portadelaidefc.com.au/news/newsarticle/tabid/6038/newsid/102958/defaul
t.aspx>
Busfield, B 2009, Performance Outcomes of Anterior Cruciate Ligament Reconstruction in the
National
Basketball Association, Arthroscopy: The Journal of Arthroscopic and Related Surgery,
accessed
14 October 2010, <http://www.arthroscopyjournal.org/article/S07498063(09)00193
5/abstract>
Donohue, C unknown date, Knee Reconstruction, Craig Donohue: Knox Orthopaedic Clinic,
accessed 13
October 2010, <http://www.donohue.com.au/kneereconstruction.html>
Gbler, M 2006, LARS Ligament and ACL Reconstruction, NSOSMC, accessed 13 October
2010,
<http://www.nsosmc.com.au/cms/uploads/practices/larspositionstatement2010.pdf>

Critical Analysis and

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

Greenburg, J 2002, An ACL revolution?, The Herald, accessed 13 October 2010,

<http://www.larsligament.com/downloads/Testimonials/Article4.pdf>
Korah, J unknown date, ADVANTAGES OF THE LARS ARTIFICIAL LIGAMENT, LARS Artificial
LIGAMENT,
accessed 14 October 2010, <http://www.larsligament.com/LARSadvantages.html>
LARS: Ligament Augmentation & Reconstruction System 2011, Corin, accessed 6 February
2011,
<http://www.coringroup.com/medical_professionals/products/ligaments/introduction/>
Malceski set for more surgery 2011, television program, Fox Sport News, Sydney, 8 March.
Muderis, M 2010, Anterior Cruciate Ligament Reconstruction, Dr. Munjed Al Muderis:
Orthopaedic
Surgeon, accessed 21 October 2010, <http://www.almuderis.com.au/common
operations/larsligament
aclreconstruction>
Osteoarthritis unknown date, MedicineNet.com, accessed 20 October 2010,
<http://www.medicinenet.com/osteoarthritis/article.htm>
Pinczewski, L 2010, LARS Ligament and ACL Reconstruction, NSOSMC, accessed 12 October
2010,
<http://www.nsosmc.com.au/cms/uploads/practices/larspositionstatement2010.pdf>
Robert, K 2009, Autograft or AllograftThat Is the Question, Orthopod, accessed 16 October
2010,
<http://www.eorthopod.com/content/autogradtorallograftthatisthequestion>
Sanders, M 2008, Sports Injuries & ACL Injury FAQ, SandersClinic.net, accessed 10 October
2010,
<http://wwww.sandersclinic.net/faq_acl.html>
Page 5 of 13

Stage 2 Physical Education issues analysis response

Ref: A196585 (revised January 2013)
SACE Board of South Australia 2012

Season over for Costa 2010, Adelaide United, accessed 15 April 2011,
<http://www.adelaideunited.com.au/default.aspx?s=newsdisplay&id=36719>
What Can I Expect after My ACL Reconstruction? 2004, eHealthMD, accessed 15 October
2010,
http://www.ehealthmd.com/library/acltears/ACL_expect.html

Page 6 of 13

Stage 2 Physical Education issues analysis response

Ref: A196585 (revised January 2013)
SACE Board of South Australia 2012

Response 2 Additional comments

Introduction displays:

Succinct explanation of necessary background information with relevant sources and establishes
why the procedure is an issue.

Analysis displays:

critical discussion of the pros/cons of the procedure with very thorough evidenced research and
appropriate use of examples

perceptive comments and relevant analysis of quotes concerning the longevity of the procedure

information derived from the survey that is appropriate although its relevance is not indicated.

Conclusion displays:

logical explanation based upon the evidence provided in the response expressing an informed
opinion.

Referencing:

very comprehensive list of specifically accessed website information focusing on details from a range
of mostly well-credentialed sources and used effectively in the body of the response

appendices 1 3 provide relevant supportive information derived from differing sources pertinent to
the issue.

Page 7 of 13

Stage 2 Physical Education issues analysis response

Ref: A196585 (revised January 2013)
SACE Board of South Australia 2012

Appendix 1
Survey conducted in 2010: ACL Reconstruction (30 people
surveyed)
Hi, my name is

from home group

and I am currently studying

Physical Education. We have been given an assignment to research a topic based on

issues in
sport. The topic that I am researching is If the LARS ACL surgery is the pathway for
athletes to
undertake for ACL surgery compared to the traditional ACL surgery. Thank you for
your time
and your answers would be greatly appreciated.
Gender (Circle answer)
o

Male

Female

Have you heard about the LARS ACL surgery? Tick in the appropriate boxes
below.
YES [ ]

NO [ ]

If you knew that the LARS ACL surgery offers a shorter recovery but
doesnt guarantee a long term
warranty in comparison to the traditional surgery then would you
recommend undertaking this
surgery? Tick in the appropriate boxes below.
YES [ ]

NO [ ]

Whats the best age for athletes to use the LARS ACL surgery? You are
given that the LARS ACL surgery
offers a shorter recovery and instant strength in knee but doesnt
guarantee long term warranty and
prevention against premature arthritis. Explain answer.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Page 8 of 13

Stage 2 Physical Education issues analysis response

Ref: A196585 (revised January 2013)
SACE Board of South Australia 2012

______________________________________________________________________

Do you believe that more research should be done on the long term
warranty of the LARS ACL surgery
before it is available for professional athletes to use? Tick in the appropriate
boxes below.
YES [ ]

Page 9 of 13

NO [ ]

Stage 2 Physical Education issues analysis response

Ref: A196585 (revised January 2013)
SACE Board of South Australia 2012

Appendix 2
Email response from

, Sports Doctor at

South Australia
Email sent: 26 November 2010 at 11:20am
Email replied: 26 November 2010 at 8:30pm
Critical Analysis and
Evaluation
Thorough and focused
use of information from
different sources with
appropriate
acknowledgment.

Page 10 of 13

Stage 2 Physical Education issues analysis response

Ref: A196585 (revised January 2013)
SACE Board of South Australia 2012

Appendix 3
Interview
Person Interviewed:

, Sports Physician

Date of Interview: 27/1/11

Place of Interview:

What benefits do you see the LARS surgery has over the traditional ACL
surgery?

Quicker recovery: Original method takes 18 months to reach 100% however

most elite
athletes return at 12 months. The LARS offers athletes to return after a
maximum 6
months rehab.

Not taking own body tissue to replicate original ACL: Generally hamstring
restores to
only 95% of full capacity for strength and speed.

What negatives do you see the LARS surgery has over the traditional ACL
surgery?

Long term warranty: Not suitable for elite athletes as it will eventually wear
out through
continuous vigorous activity such as twisting and turning. Quotes The LARS
is like a new
set of tires for a car. If you drive conservative then you will cover more
distance.
However if you are hoon driving, the tires will deteriorate and fail quicker.

What situation do you believe that the LARS would be most beneficial for
professional
athletes?

Not option for elite and young athletes

Maybe useful for older athletes who have a limited time to return to
competition or are
at the end of their career. A scenario could be using the LARS as a quick fix
if an
Olympic athlete ruptures their ACL a few months before the Olympics. So
they are able
to compete at near full capacity.

Page 11 of 13

Stage 2 Physical Education issues analysis response

Ref: A196585 (revised January 2013)
SACE Board of South Australia 2012

Believes that harvesting hamstring grafts is the best option for ACL
reconstruction for
elite athletes as the LARS cant sustain the strength needed for elite
competition long
enough. The LARS could be seen as a quick fix for athletes before major
competitions.

Page 12 of 13

Stage 2 Physical Education issues analysis response

Ref: A196585 (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 13 of 13

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: A196585 (revised January 2013)
SACE Board of South Australia 2012