Advice

Summary

Summary

The LARS (ligament augmentation and reconstruction system) is a synthetic scaffold indicated for the repair and reconstruction of damaged ligaments. Comparative studies show no statistically significant differences in the majority of outcomes for people undergoing LARS procedures compared with people treated with an autograft at a follow‑up of 4 years. One study reported statistically significantly less laxity for LARs procedures. Each LARS costs £1391.

Product summary and likely place in therapy

  • The LARS is a synthetic ligament for use as scaffolding in the reconstruction of damaged anterior or posterior cruciate knee ligaments.

  • The LARS would only be used in ligament repair procedures when the clinician and patient have decided that non‑synthetic alternatives (autograft and allografts) have been considered as possible treatment options. The LARS can be used instead of autograft or allograft procedures, if sufficient native tissue remains, or alongside these grafts to protect the joint.

Effectiveness and safety

  • Five comparative studies (1 randomised controlled trial and 4 cohort comparative studies) investigated the effectiveness of the LARS in cruciate knee ligament reconstructions. These studies reported measures of knee stability and patient‑reported outcomes. No statistically significant differences were reported in the majority of outcomes for people having LARS procedures compared with people having autograft treatment at a follow‑up of 4 years. One study reported statistically less laxity for LARS procedures.

  • One systematic review provided safety information on synthetic ligament scaffolds including the LARS. LARS had the lowest failure rate at 2.4% of procedures, with the highest reported failure rate being 33.6%. Revision rates ranged from 2.2% with the LARS to 11.8%. No corresponding rates for autograft or allograft were reported.

Technical factors

  • The LARS is made of polyethylene terephthalate (PET).

  • Each LARS is composed of 2 sections (intra‑ and extra‑articular). The design aims to mimic normal ligament anatomy and overcome fibre breakdown, which can lead to synovitis.

  • The LARS is available in different sizes. It is generally fixed into place using 2 screws.

Cost and resource use

  • The cost of the LARS, excluding fixings, is £1391, excluding VAT. Fixing screws, which are also needed for other ACL reconstruction techniques, cost £153 each.

  • It has been suggested that the LARS reduces rehabilitation time and has a lower failure rate than autografts or allografts, which could lead to resource savings. However, there is currently little evidence to support these claims.