Anterior cruciate ligament reconstruction with the ligament augmentation and reconstruction system: a systematic review

Purpose

The Ligament Augmentation and Reconstruction System (LARS) is a third generation of synthetic ligament, designed to overcome the issues of graft failure and synovitis which led previous generations of synthetic ligaments to fall out of favour. The theoretical benefits of LARS are appealing but this has not led to widespread uptake of the system in preference to autograft. The aim of this systematic review is to assess whether the evidence exists to support the use of LARS with respect to outcomes and complications.

Methods

A systematic search process was undertaken from January 1990 to June 2012 to identify primary evidence relating to the use of LARS in anterior cruciate ligament (ACL) single ligament reconstruction.

Results

Nine studies were found meeting the search criteria including a single randomised controlled trial, two comparative series and six further observational case series. Overall the methodological quality of the studies was poor with follow-up to a maximum of five years. Reported outcome scores were good for LARS and comparable to autograft techniques. Complication rates were low and comparable to those published for autograft techniques within the wider literature. Two reported incidences of synovitis were identified in case reports.

Conclusions

The current literature supports the use of LARS in the short to medium term. However, high-quality studies with long-term follow-up are required to determine whether the use of LARS is preferable to autograft for ACL reconstruction over the longer term. Synovitis appears to be a rare complication closely related to imperfect graft positioning.