Anterior Cruciate Ligament Reconstruction in Patients Older Than 50 Years: A Systematic Review and Meta-analysis

Abstract

Background: There is no consensus regarding the best treatment approach for middle-aged patients with anterior cruciate ligament (ACL) injuries. Chronic ACL-deficient knees are often associated with instability as well as secondary meniscal and cartilage lesions. ACL reconstruction (ACLR) has achieved satisfactory outcomes in younger patients; however, the effectiveness and safety of ACLR in middle-aged patients remain uncertain. Purpose: To compare the patient-reported functional scores, arthrometric outcomes, and complications of primary ACLR between older (≥50 years) and younger (<50 years) patients. Study Design: Systematic review; Level of evidence, 3. Methods: We conducted a systematic review of cohort studies that compared the clinical outcomes of ACLR between patients aged ≥50 years and those aged <50 years. The Cochrane Central Register of Controlled Trials, Embase, and MEDLINE databases were searched for relevant studies. The Methodological Index for Non-randomized Studies (MINORS) criteria was used to assess the risk of bias and conducted a random-effects meta-analysis to combine the data, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the overall quality of the body of retrieved evidence. The primary outcome was knee functional outcomes, and secondary outcomes were arthrometric outcomes of ACLR and complications. Results: This study included 4 retrospective cohort studies with a total of 287 participants (129 in the older group and 158 in the younger group). All included studies reported significant improvements in clinical outcomes in both groups after ACLR. No significant differences were noted in the improvement of International Knee Documentation Committee (IKDC) scores (mean difference [MD], 0.20 [95% CI, −2.65 to 3.05]; P = .89) and Lysholm scores (MD, −1.98 [95% CI, −6.93 to 2.98]; P = .43) between the 2 groups. No significant differences were observed in anteroposterior stability or risk of complications between the groups. Conclusion: ACLR may be performed in middle-aged patients (≥50 years) without concern for inferior clinical and arthrometric results compared with younger patients (<50 years).

Patients Aged 50 Years and Older Have Greater Complication Rates After Anterior Cruciate Ligament Reconstruction: A Large Database Study

“…However, this prior meta-analysis was unable to assess for differences in complication rates due to their low incidence after ACL reconstruction and the limited number of patients included in the analysis. Compared with the study by Tan et al., 21 the current study highlights this difference in complication rates, with the most notable difference being the rate of DVT/PE in older patients.…”

“…A recent meta-analysis including four retrospective cohort studies and a total of 287 patients (129 older than 50 years, 158 younger than 50 years) found no difference in the improvement of International Knee Documentation Committee scores or Lysholm scores between patients older than and younger than 50 years old. 21 There was also no difference in Tegner activity scores or the incidence of knee AP laxity as measured on KT-1000 or KT-2000 arthrometer at final followup. 21 All studies included in the meta-analysis reported AGE IMPACTS COMPLICATIONS AFTER ACLR e5 significant improvement in clinical outcomes across both patient age groups.…”

“…21 There was also no difference in Tegner activity scores or the incidence of knee AP laxity as measured on KT-1000 or KT-2000 arthrometer at final followup. 21 All studies included in the meta-analysis reported AGE IMPACTS COMPLICATIONS AFTER ACLR e5 significant improvement in clinical outcomes across both patient age groups. 21 These findings indicate that ACL reconstruction in patients older than 50 years old results in similar knee stability and function scores compared to younger patients.…”

“…21 All studies included in the meta-analysis reported AGE IMPACTS COMPLICATIONS AFTER ACLR e5 significant improvement in clinical outcomes across both patient age groups. 21 These findings indicate that ACL reconstruction in patients older than 50 years old results in similar knee stability and function scores compared to younger patients. However, this prior meta-analysis was unable to assess for differences in complication rates due to their low incidence after ACL reconstruction and the limited number of patients included in the analysis.…”

Preoperative factors associated with failure to reach the patient acceptable symptom state after anterior cruciate ligament reconstruction in patients aged 40 and older

“…There is considerable controversy surrounding the role for surgery in older patient populations with ACL tears [3, 8, 9, 30, 31, 35, 37, 38]. Patients under the age of 40 who undergo nonsurgical management of these injuries are at increased risk of sustaining subsequent meniscal and chondral injuries and may develop knee osteoarthritis at a higher rate than those who receive ACLR [3, 10, 17, 18, 22, 23].…”