# LARS‐augmented hamstring ACL reconstruction shows better early but similar long‐term outcomes compared with hamstring autograft alone: A systematic review and meta‐analysis

## TL;DR

Using LARS with hamstring grafts in ACL surgery helps with early recovery and return to sport but has similar long-term results as using the graft alone.

## Contribution

This study is the first systematic review and meta-analysis comparing LARS-augmented hamstring ACLR with standard hamstring autografts.

## Key findings

- LARS-augmented ACLR showed better early functional outcomes and quicker return to sport.
- No significant difference in anterior laxity between LARS-augmented and standard hamstring autografts.
- Long-term outcomes were similar between the two groups.

## Abstract

This systematic review aimed to evaluate whether augmenting hamstring autografts with the Ligament Augmentation and Reconstruction System (LARS) during anterior cruciate ligament reconstruction (ACLR) enhances early recovery, improves functional outcomes, and accelerates return to sport (RTS), compared to standard hamstring autografts alone. With increasing emphasis on accelerated rehabilitation, the study seeks to clarify the clinical role of synthetic graft augmentation.

Following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta‐Analyses) guidelines, a comprehensive systematic review was conducted focusing on ACLR using hamstring autografts augmented with LARS. The protocol was registered on PROSPERO (CRD42024536835). A literature search was performed using PubMed and Scopus databases. Primary outcome was anterior laxity based on KT‐1000, while secondary outcomes included the Lysholm score, Tegner activity scale, Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), anterior cruciate ligament‐return to sport after injury (ACL‐RSI), complication rates, graft failure and RTS. Methodological quality was assessed using the Newcastle–Ottawa Scale. Six studies involving a total of 764 patients met the inclusion criteria.

LARS‐augmented ACLR was associated with significantly better early functional outcomes, including higher Lysholm, IKDC and Tegner scores (standardized mean difference [SMD] = 0.83, 0.5 and 0.72, respectively), higher psychological readiness (ACL‐RSI) and earlier RTS. KT‐1000 measurements showed no statistically significant difference between the hybrid and autograft groups. However, long‐term outcome differences between augmented and non‐augmented groups were minimal.

LARS augmentation in ACLR is a promising technique, supporting early rehabilitation, secure graft stability and timely return to activity, potentially benefiting older individuals or those with higher body mass index (BMI). Selective use of LARS may be advantageous in high‐demand patients or early RTS protocols, while future implications could include augmentation in case of suboptimal graft quality.

Level III.