Clinical and functional outcomes of isolated posterior cruciate ligament reconstruction in patients over the age of 40 years

Abstract

Background To assess clinical and functional outcomes of patients aged 40 years or older receiving PCL reconstruction surgery. Methods All patients older than 40 years with isolated PCL rupture who underwent PCL reconstruction surgery were enrolled into the retrospective study. Associated meniscal injuries, osteochondral lesions, postoperative complications, and the rate of return to the preinjury level of activity were extracted. Outcomes included International Knee Documentation Committee (IKDC) subjective score, Lysholm score, and Tegner activity score. The minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were used to evaluate the clinically relevant value of PCL reconstruction in this population. Results In total, 41 patients with a mean age of 51.7 years were included. The mean follow-up time was 32.8 months. Associated lesions included meniscal injuries (48.8%) and osteochondral lesions (97.6%). Improvement in the IKDC score (from 46.5 preoperatively to 79.0 postoperatively, p < 0.0001), Lysholm score (from 65.5 to 88.3, p < 0.0001), and Tegner activity score (from 2.3 to 4.0, p < 0.0001) was recorded. The clinically relevant value based on the MCID showed that 34 of 41 patients (82.9%) had a ΔIKDC score exceeding 16.8; all patients (100%) showed a ΔLysholm score exceeding 8.9; and 35 of 41 patients (85.4%) showed a ΔTegner activity score exceeding 0.5. Regarding the PASS, none of the patients had an IKDC score exceeding 75.9 preoperatively, whereas 27 of 41 patients (65.9%) had a score of more than 75.9 postoperatively. All patient had ≥ grade II knee instability preoperatively. Postoperatively, 36 patients (87.8%) had no significant joint translation, and 5 patients (12.2%) had grade I instability. Twenty-one patients (51.2%) returned to their preinjury level of activity. Five patients (12.2%) developed Ahlbäck grade I radiographic osteoarthritis. No rerupture or other major perioperative complications were reported. Conclusions PCL reconstruction is a reliable surgery for middle-aged patients suffering from persistent instability even after failed conservative treatment, with significant improvement in patient-reported outcomes that exceeded MCID in the majority of patients, restoration of subjective instability, and approximately half of the patients returned to preinjury activity levels. Level of evidence Level IV, therapeutic case series.

Technique and Outcomes of Posterior Cruciate Ligament Repair With Augmentation

“…In light of this, some of our secondary analyses may have been underpowered; specifically, we found a trend toward differences in IKDC scores among PCL tear location subgroups that did not reach statistical significance (femoral-sided vs midsubstance vs tibial-sided; P = .07). However, the largest magnitude group difference among these 3 subgroups was 8.5 points (does not exceed recently reported IKDC minimal clinically important difference values of 16.8 and 16.7 from studies of Liu et al 30 and Chen et al, 8 respectively). Further, patient outcomes data in a cohort with a high proportion of MLKI, as in the present cohort, are vulnerable to confounding because of concomitant injuries.…”

Outcome Analysis of Posterior Cruciate Ligament Injuries: A Narrative Review

“…No major complications were noted, with a minimum follow-up time of two years. Approximately half of the patients returned to activities at their preinjury level [35].…”

Epidemiology of cruciate ligament surgery in Japan: A repeated cross-sectional study from 2014 to 2021

“…Additionally, there is a higher risk of knee joint dysfunction and secondary injuries (such as meniscus and cartilage damage) [31,32]. Good outcomes of CL surgery in middle-aged and older patients have also been reported [33,34]. Consequently, many patients may choose surgery to regain their previous level of activity.…”