Comparison of clinical outcomes between ligament augmentation reconstruction system and conventional repair for acute Achilles tendon rupture: a retrospective cohort study

BACKGROUND: Achilles tendon rupture (ATR) often limits early rehabilitation following conventional repair. The ligament augmentation reconstruction system (LARS) offers immediate mechanical stability and enables early mobilization. However, few studies have directly compared LARS with conventional suture techniques in ATR. PURPOSE: To compare the efficacy and safety of the LARS versus the conventional Kessler suture technique for managing acute closed ATR. STUDY DESIGN: Retrospective Cohort Study. METHODS: A retrospective analysis was conducted on 91 patients who underwent surgical repair for ATR. The cohort was divided into two groups: 59 patients were treated with the LARS and 32 with the conventional Kessler suture technique. Functional outcomes were assessed using the Achilles tendon Total Rupture Score (ATRS) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score at 3, 6, and 12 months postoperatively. Complications and re-rupture rates were systematically documented and compared between the groups. RESULTS: At the 3-month follow-up, the LARS group demonstrated significantly superior functional outcomes, with markedly higher ATRS (78.00 ± 15.01 vs. 55.00 ± 16.30, P < 0.001) and AOFAS scores (87.03 ± 5.44 vs. 82.03 ± 3.92, P < 0.001) compared to the conventional repair group. This superiority was maintained at the 6-month assessment for both the ATRS (88.00 ± 12.18 vs. 76.00 ± 13.23; P < 0.001) and AOFAS scores (94.78 ± 4.90 vs. 89.06 ± 4.54; P < 0.001). However, by 12 months postoperatively, the differences in both ATRS and AOFAS scores between the two groups were no longer statistically significant (P > 0.05). The LARS group reported one case of gastrocnemius weakness, while the conventional group experienced two cases of delayed wound healing and one superficial infection. CONCLUSION: LARS repair enables a faster functional recovery in the short term compared to conventional Kessler repair, without increasing complication rates. While both techniques yield comparable excellent results by one year, the accelerated recovery pathway provided by LARS establishes it as a safe and effective treatment option, especially valuable for patients requiring an early return to activity.