Acromioclavicular Joint Reconstruction Using the Ligament Advanced Reinforcement System Technique: A Systematic Review

Abstract

The acromioclavicular (AC) joint is crucial for shoulder function. Injuries, often in young males, result from trauma or degeneration. Treatment ranges from conservative to surgical. The Ligament Advanced Reinforcement System (LARS) technique was noted for restoring stability and function. In this review, we evaluate the LARS technique for AC joint reconstruction, focusing on clinical outcomes and complications. A literature search was done in May 2024 across PubMed, Scopus, Google Scholar, and Cochrane Library using keywords such as "acromioclavicular joint," "reconstruction," and "LARS." Inclusion criteria covered studies on the LARS technique. Data extraction included study design, patient demographics, surgical details, follow-up, and outcomes. The study quality was assessed using the Risk of Bias in Non-Randomized Studies of Interventions. Data were synthesized via meta-analyses. Also, publication bias was evaluated using funnel plots and Egger’s test. From 200 records, three studies with 114 patients met the inclusion criteria. Meta-analysis showed significant improvements in functional recovery and pain reduction post-LARS surgery. Constant-Murley scores improved from a mean of 62.3 to 94.5. Visual analog scale pain levels decreased from 5.1 to 0.7. Despite high heterogeneity (I²=96%), the overall effect size strongly favored the LARS technique (standardized mean difference=-4.12 (95% CI: -4.63 to -3.60)). Complications were generally low, with calcification occurring in four patients, degenerative changes in two, and minor graft failures in another two. Patient satisfaction was high because they reported significant improvements in function and pain. Egger’s test indicated no strong evidence of publication bias (p=0.083). The LARS technique enhances functional recovery and reduces pain. However, further research with larger, standardized studies and longer follow-ups is needed.