Abstract
OBJECTIVE: This study aimed to evaluate the comparative efficacy of the Ligament Advanced Reinforcement System (LARS) artificial ligament vs. autologous hamstring tendons in patients undergoing anterior cruciate ligament (ACL) reconstruction with remnant preservation, with particular focus on proprioceptive recovery, joint stability, functional outcomes, return-to-sport timelines, and complication profiles during early to mid-term follow-up. METHODS: We conducted a retrospective cohort analysis of 162 consecutive patients who underwent arthroscopic ACL reconstruction with remnant preservation between January 2020 and June 2023. Participants were stratified into two treatment groups: the LARS cohort (n = 70) and the autograft cohort (n = 92). Baseline demographic and clinical characteristics demonstrated comparability between groups. Standardized assessments were performed at 3, 6, 12, and 24 months postoperatively, including evaluation of proprioceptive threshold (TDPM), anterior knee stability (Ligs Digital Ligament Assessment Device), functional capacity (Lysholm score, IKDC subjective score, Tegner activity scale), return-to-sport progression, and complication incidence. RESULTS: The autograft group exhibited significantly superior proprioceptive recovery, as evidenced by lower TDPM values at both 6 and 12-month intervals (P < 0.05). Enhanced anterior stability was observed in the LARS cohort at the 3-month assessment (P < 0.001), though this advantage diminished by 12 months. Conversely, the autograft group demonstrated significantly better patient-reported outcomes on both Lysholm and IKDC scales at the 12-month follow-up (P < 0.05). While the LARS group achieved higher return-to-sport rates at 12 months, the autograft group showed superior long-term sports participation at 24 months. The autograft cohort experienced 4 cases of Cyclops lesions, whereas no such complications were documented in the LARS group. CONCLUSION: Our findings suggest distinct temporal advantage patterns between the two graft types. The LARS artificial ligament may provide superior early stabilization and a quicker return to athletic activities in the short term, while autologous hamstring tendons appear to offer more favorable long-term functional outcomes, proprioceptive recovery, and sustained sports participation. These observations support the hypothesis that clinical decision-making should incorporate individual patient factors. Additionally, the remnant tensioning technique may offer potential benefits in reducing complications, though this requires further investigation to confirm causality.