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

Abstract

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...

¿Does ACL reconstruction have any influence in meniscal repair?. Sports return, quality of life and failure rate. 2-12 years follow up.

“…In a recent retrospective study by Cinque et al [34] in 85 patients with ACL reconstruction with or without meniscal repair, they found similar outcomes in quality of life than our study, using SF-12 they found in physical components medium value of 52,8, and in mental components they found 53,2 as medium value. Therefore they didn't found a statiscally signi cant difference between age and quality of life outcomes.…”

Editorial Commentary: Fifty Is the New 30? Do Patients in Their 50s Deserve an Anterior Cruciate Ligament Reconstruction?

“…Earlier, Desai et al 15 analyzed data from the Swedish ACL registry and reported lower preoperative scores in older patients but similar Knee Injury and Osteoarthritis Outcome Score scores at the 5-year follow-up, with greater overall improvement in older patients. Similar to Weng et al, 7 Cinque et al 16 also reported improved function and satisfaction in patients older than 50 years at 2 years and these results were comparable with younger patients.…”

Does ACL reconstruction have any influence in meniscal repair? Sports return, quality of life and failure rate. 2-12 years follow up.

“…Fuch et al found high outcomes in quality of life in isolated meniscal repair, with a follow up of 3 years, measured by KOOS QOL, with a medium score of 81.8 ± 12.1. (32) In a recent retrospective study by Cinque et al (33), in 85 patients with ACL reconstruction with or without meniscal repair, they found similar outcomes in quality of life than our study, using SF-12 they found in physical components medium value of 52,8, and in mentall components they found 53,2. And also they didn't found a statiscally signi cant difference between ages and quality of life outcomes.…”