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by Lisa Albergo reporting for AFANA from Chicago

Sydney's Nick Malceski can be considered an AFL pioneer. Several years ago, he wrecked his knee late in the season and was facing a year on the sidelines until a new procedure came along. The LARS system, which uses synthetic fibers to create tissue, saw Malceski back on the field after just four months. Since that time, Port Adelaide's David Rodan and Carlton's Brad Fisher have also undergone the procedure. Port's Warren Tredrea, who recently announced his retirement, had the procedure on his ankle.

However, leading surgeons have expressed concerns that there has not been enough research completed and that a false sense of recovery security could lead to arthritis** later on. Another concern is how long the synthetic ligaments will actually last. Even the doctor who performed the operation on Fisher said the revolutionary system, which is not approved in the USA, was not perfect. He also cautioned that the procedure might not be appropriate in some cases and said that "... everyone expects that if an AFL player has this surgery it must be fantastic."

Dr Julian Feller, who performed the traditional knee reconstruction (which uses a graft of the patient's own tissue to effect the repair) on Carlton ruckman Matthew Kreuzer believes the lack of solid studies and literature is a concern. Kreuzer, although a candidate for the LARS method, opted for the traditional surgery.

Another respected surgeon, David Young, who used synthetic ligaments in some 200 odd knee surgeries 20 years ago, now advocates the use of natural tissue over synthetics. He believes there are too many disadvantages and potential problems with synthetic tissue. His concern centers around the fact that part of the bone has to be drilled away during the LARS procedure. He said the more bone which had to be removed, the more complicated a second surgery would be if the first failed for some reason. He voiced concern about how quickly players were resuming running, saying it could result in premature arthritis**. He said this could be caused because it takes 12-16 weeks for the articular cartilage and joint fluid to return to normal after the initial trauma and surgery. He further stated that his first rule was that no patient of his was allowed to run for four months. He said allowing someone to run after just six to eight weeks was an invitation for premature arthritis** and he definitely does not recommend it for younger athletes.

Sports physician Peter Larkins, who has been involved with footy for years, also raised the concern regarding the longevity of the LARS ligament. He said, "If you have a young bloke, with ... a big career ahead, you don't want him busting his LARS in two years." Dr. Norsworthy, the physician concerned about the lack of research, also stated that the "... message definitely hasn't gotten across ... certainly not in the general public" and reiterated his warning of caution in the use of the LARS system.

**this type of arthritis is known as osteoarthritis, which only affects joints which have suffered a trauma and does not spread to other joints like rheumatoid arthritis -

Article last changed on Tuesday, January 27, 2015 - 12:10 AM EST

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