Is There Any Benefit in Anterior Cruciate Ligament Reconstruction in Patients Older Than 60 Years?

Toanen, Cécile; Demey, Guillaume; Ntagiopoulos, Panagiotis G.; Ferrua, Paolo; Dejour, David

doi:10.1177/0363546516678723

Cited by 76 publications

(98 citation statements)

References 15 publications

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“…20 With the advent of an anatomic surgical technique, the availability of enhanced instrumentation, the use of an improved and more aggressive rehabilitation protocol, and a better understanding of the immediate and long-term consequences of untreated knee instability, surgical indications for ACL insufficiency have been extended to active patients of all ages. 29 …”

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confidence: 99%

Outcomes and Complication Rates After Primary Anterior Cruciate Ligament Reconstruction Are Similar in Younger and Older Patients

Cinque

Chahla

Moatshe

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Until recently, anterior cruciate ligament (ACL) tears in older patients were treated conservatively; however, these patients often experienced significant pain and instability.Purpose/Hypothesis:The purpose of this study was to compare the patient-reported outcomes, patient satisfaction, and failure rates of primary ACL reconstruction between a younger (age 20-30 years) and older (age 50-75 years) patient cohort. It was hypothesized that patients in the older cohort could achieve comparable clinical outcomes and retear rates following ACL reconstruction with a bone-tendon-bone autograft or allograft compared with the younger patients.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective analysis of prospectively collected data was performed. All patients undergoing a primary ACL reconstruction between 2010 and 2014 by a single surgeon were collated. Patients were divided into 2 groups based on age at the time of surgery: a younger cohort (20-30 years) and an older cohort (50-75 years). Patients were excluded if they were outside the desired age intervals; had revision ACL reconstructions; had a previous intra-articular infection in the ipsilateral knee; underwent prior alignment correction procedure, cartilage repair, or transplant procedure; had a concurrent posterior cruciate ligament tear; received meniscal allograft transplant; or had an intra-articular fracture. Subjective outcome scores (Tegner activity scale, Lysholm, International Knee Documentation Committee [IKDC], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], Short Form–12 [SF-12] mental health component summary [MCS], and SF-12 physical component summary [PCS]), retear rate, and rate of secondary arthrofibrosis surgery were documented at a minimum 2-year follow-up and were compared between groups.Results:A total of 85 patients met the inclusion criteria for this study: 52 patients (33 males, 19 females) in the younger cohort and 33 patients (14 males, 19 females) in the older cohort. No significant differences were found in any demographic factor except for age. Significant improvement in outcome scores from pre- to postoperative assessments was found in both groups. The younger cohort had significantly lower postoperative WOMAC scores (P = .025). However, no significant differences were found between the younger and older cohorts in postoperative SF-12 PCS (P = .487), SF-12 MCS (P = .900), Lysholm score (P = .660), IKDC score (P = .256), Tegner activity score (P = .420), or patient satisfaction (P = .060). Within the older cohort, increasing age did not correlate with inferior postoperative outcome scores. Furthermore, no retears occurred in either group, and the rates of arthrofibrosis surgery were comparable (12% older cohort vs 13% younger cohort).Conclusion:Improved function and satisfaction, comparable to the younger age group, were achieved in patients older than 50 years undergoing ACL reconstruction. Furthermore, low failure rates can be achieved in both younger and older patients underg...

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confidence: 99%

Outcomes and Complication Rates After Primary Anterior Cruciate Ligament Reconstruction Are Similar in Younger and Older Patients

Cinque

Chahla

Moatshe

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…The authors concluded that age over 50 years is not a contraindication to select a hamstring autograft for ACLR. 55 Toanen et al 56 demonstrated that older and active patients >60 years without osteoarthritis showed good results after single-bundle hamstring autograft ACLR. The majority of patients (83%) returned to sports activities with 50% returning to their preinjury level of activity.…”

Section: Resultsmentioning

confidence: 99%

ACL reconstruction with hamstring tendon autograft and accelerated brace-free rehabilitation: a systematic review of clinical outcomes

Janssen

Melick²,

Mourik

et al. 2018

BMJ Open Sport Exerc Med

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ObjectiveTo investigate the clinical outcomes after hamstring tendon autograft ACL reconstruction (ACLR) with accelerated, brace-free rehabilitation.DesignSystematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.Data sourcesEmbase, MEDLINE Ovid, Web of Science, Cochrane CENTRAL and Google scholar from 1 January 1974 to 31 January 2017.Eligibility criteria for selecting studiesStudy designs reporting outcomes in adults after arthroscopic, primary ACLR with hamstring autograft and accelerated, brace-free rehabilitation.ResultsTwenty-four studies were included in the review. The clinical outcomes after hamstring tendon autograft ACLR with accelerated brace-free rehabilitation were the following: (1) early start of open kinetic exercises at 4 weeks in a limited range of motion (ROM, 90°−45°) and progressive concentric and eccentric exercises from 12 weeks did not alter outcomes, (2) gender and age did not influence clinical outcomes, (3) anatomical reconstructions showed better results than non-anatomical reconstructions, (4) there was no difference between single-bundle and double-bundle reconstructions, (5) femoral and tibial tunnel widening occurred, (6) hamstring tendons regenerated after harvest and (7) biological knowledge did not support return to sports at 4–6 months.ConclusionsAfter hamstring tendon autograft ACLR with accelerated brace-free rehabilitation, clinical outcome is similar after single-bundle and double-bundle ACLR. Early start of open kinetic exercises at 4 weeks in a limited ROM (90°−45°) and progressive concentric and eccentric exercises from 12 weeks postsurgery do not alter clinical outcome. Further research should focus on achievement of best balance between graft loading and graft healing in the various rehabilitation phases after ACLR as well as on validated, criterion-based assessments for safe return to sports.Level of evidenceLevel 2b; therapeutic outcome studies.

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“…The first study of patients who had ACL reconstruction after 60 years of age was reported in January 2017 by Toanen et al [15]. Only 12 patients were included.…”

Section: Discussionmentioning

confidence: 99%

Influence of operative technique on anterior cruciate ligament reconstruction in patients older than 50 years

Ode¹,

Gonzalez²,

Paihle³

et al. 2019

Orthopaedics & Traumatology: Surgery & Research

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Background: A consequence of the steady growth in the worldwide population of elderly individuals who remain in good health and continue to engage in sports is an increase in the incidence of anterior cruciate ligament (ACL) rupture occurring after 50 years of age. ACL reconstruction was formerly reserved for young athletes but now seems to produce good outcomes in over 50s. The type of graft and graft fixation method were selected empirically until now, given the absence of investigations into potential relationships of these two parameters with the outcomes. The objective of this study was to assess associations linking the type of graft and the method of femoral graft fixation to outcomes in patients older than 50 years at ACL reconstruction. Hypothesis: The operative technique is not associated with the clinical outcomes or differential laxity. Material and methods: A multicentre retrospective cohort of 398 patients operated between 1 January 2011 and 31 December 2015 and a multicentre prospective cohort of 228 patients operated between 1 January 2016 and 30 June 2017 were conducted. Mean follow-up was 42.7 months in the retrospective cohort and 14.2 months in the prospective cohort. The primary evaluation criterion was the clinical outcome as assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Tegner Activity Score (TAS). Differential laxity was the secondary evaluation criterion. The Wilcoxon rank sum test and Kruskal-Wallis test were used to compare groups, and p-values < 0.05 were considered significant. Results: In the retrospective and prospective cohorts, hamstring tendons were used in 269 (67.6%) and 197 (86.4%) patients and extensor apparatus tendons in 124 (31.2%) and 31 (13.6%) patients. Femoral fixation in the retrospective cohort was cortical in 81 (20.4%) cases, by press-fit in 112 (28.1%) cases, and by interference screw in 205 (51.5%) cases; corresponding figures in the prospective cohort were 135 (59.2%), 17 (7.5%), and 76 (33.3%). The multivariate analysis of the retrospective data identified no significant associations of graft type or femoral fixation type with the KOOS, TAS, or differential laxity values. In the prospective cohort, hamstring grafts were associated with 0.6 mm of additional laxity (p = 0.007); compared to cortical fixation, press-fit fixation of patellar tendon grafts was associated with 0.3 mm of additional laxity (p = 0.029) and a 0.5-point lower TAS value (p = 0.033), with no difference in KOOS values. None of these differences were clinically significant. Discussion: The various ACL reconstruction techniques used in patients older than 50 years produce similar outcomes. The technique can be chosen based on surgeon preference without regard for patient age. Level of evidence: IV.

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Is There Any Benefit in Anterior Cruciate Ligament Reconstruction in Patients Older Than 60 Years?

Cited by 76 publications

References 15 publications

Outcomes and Complication Rates After Primary Anterior Cruciate Ligament Reconstruction Are Similar in Younger and Older Patients

Outcomes and Complication Rates After Primary Anterior Cruciate Ligament Reconstruction Are Similar in Younger and Older Patients

ACL reconstruction with hamstring tendon autograft and accelerated brace-free rehabilitation: a systematic review of clinical outcomes

Influence of operative technique on anterior cruciate ligament reconstruction in patients older than 50 years

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