Factors affecting outcome of ACL reconstruction in over-50-year-olds

Abstract

Introduction: With increasing life expectancy and ever-improving quality of life in industrialized countries, functional demand and sports levels are increasing in older subjects, who are thus exposed to central pivot lesions almost as much as younger ones. While non-operative treatment provides acceptable results, it entails significant reduction in sports level. The aim of the present study was to analyze mediumterm clinical, functional and radiological results of anterior cruciate ligament (ACL) reconstruction in over-50-year-olds, in order to identify factors for failure. Hypothesis: The study hypothesis was that surgical management provides good results if patient selection is rigorous. Patients and methods: A multicenter retrospective study included 398 patients undergoing ACL reconstruction between April 1, 2009 and December 6, 2016. Inclusion criteria comprised: age ≥ 50 years, with proven ACL tear. Preoperatively, clinical work-up was supplemented by measurement of differential anterior laxity and radiologic assessment of cartilage status. Functional level was assessed on the objective IKDC score. Intraoperative data comprised type of graft and meniscal and cartilage status. The same parameters were assessed postoperatively. Functional results were assessed on objective IKDS, KOOS and ACL-RSI scores. Results: The mean follow-up was 42.2 months. The mean improvement in differential anterior laxity was 4.2 mm. Pivot-shift showed improvement, with 97% absent or glide (p < 0.001). Objective IKDC score showed significant improvement (p < 0.0001). 23% of patients had poor clinical results: IKDC C or D. Preoperative explosive pivot-shift (p < 0.0001), medial tibiofemoral osteoarthritis (p < 0.0001) and medial meniscus lesion (p < 0.002) emerged as risk factors for poor functional outcome. Conclusion: ACL reconstruction in over-50-year-olds provided satisfactory clinical and functional results. Rigorous patient selection is mandatory, as radiologic signs of medial tibiofemoral osteoarthritis indicate a risk of poor outcome. Surgery may be proposed in patients with high functional and athletic demand, before medial meniscal lesions can set in. In case of explosive pivot shift, associated anterolateral reconstruction should be considered.

Anterior Cruciate Ligament Reconstruction Using Bone–Patellar Tendon–Bone Allograft in Patients Aged 50 and Older Leads to Improved Activity Levels and Acceptable Patient-Reported Outcomes

“…Good outcomes have been shown in several other studies of ACLRs in older patients using various grafts, with the most commonly studied grafts being hamstring allograft and autograft. 12,13,23,[31][32][33] Fayard et al 33 investigated outcomes of ACLR in a multicenter retrospective study of 398 patients older than the age of 50 years. Their cohort consisted of 32% BPTB grafts and 68% hamstring grafts, although they did not specify the proportion of allograft and autograft.…”

“…Good outcomes have been shown in several other studies of ACLRs in older patients using various grafts, with the most commonly studied grafts being hamstring allograft and autograft. 12 , 13 , 23 , 31 , 32 , 33 Fayard et al. 33 investigated outcomes of ACLR in a multicenter retrospective study of 398 patients older than the age of 50 years.…”

“… 12 , 13 , 23 , 31 , 32 , 33 Fayard et al. 33 investigated outcomes of ACLR in a multicenter retrospective study of 398 patients older than the age of 50 years. Their cohort consisted of 32% BPTB grafts and 68% hamstring grafts, although they did not specify the proportion of allograft and autograft.…”

Anterior cruciate ligament reconstruction in the over-50s. A prospective comparative study between surgical and functional treatment

“…The main aim of the present multicenter prospective study, launched by the 2018 French Arthroscopy Society (SFA) symposium [17][18][19], was to compare results between surgical and non-surgical treatment of ACL tear in over-50 year-olds. Secondary objectives comprised:…”

Biomechanical comparison of the use of different surgical suture techniques for continuous loop tendon grafts preparation

“…Untreated ACL rupture can be associated with the occurrence of knee osteoarthritis and knee instability 2 . Therapeutic strategies of ACL ruptures have received extensive attention from scholars and with the development of sports medicine and arthroscopic techniques, arthroscopic anterior cruciate ligament reconstruction (ACLR) has become the most common surgical strategy for the treatment of ACL rupture 3 .…”