Outcomes of the patellar tendon and hamstring graft anterior cruciate ligament reconstructions in patients aged above 50 years

Abstract

Background:The treatment of anterior cruciate ligament (ACL) injury consists of arthroscopic ACL reconstruction with patellar tendon or hamstring graft. Satisfactory results have been reported so far in the younger age group. Dilemma arises regarding the suitability of ACL reconstruction in patients aged 50 years and above. This retrospective analyses the outcome of ACL reconstruction in patients aged 50 years and above.Materials and Methods:55 patients aged 50 years and above presented to our institution with symptomatic ACL tear and were managed with arthroscopic reconstruction with patellar tendon/hamstring graft. 22 patients underwent ACL reconstruction with bone- patellar tendon-bone graft and the remaining 33 with a hamstring graft. Evaluation of functional outcome was performed using International Knee Documentation Committee (IKDC) and Lysholm scoring in the preoperative period, at the end of 1 year and at the final followup. Radiographic evaluation was performed using the Kellgren–Lawrence grading system.Results:The mean preoperative IKDC score was 39.7 ± 3.3. At the end of 1-year following the operation, the mean IKDC score was 73.6 ± 4.9 and at the final followup was 67.8 ± 7.7. The mean preoperative Lysholm score was 40.4 ± 10.3. At the end of 1-year following the intervention, the mean Lysholm score was 89.7 ± 2.1 and at final followup was 85.3 ± 2.5. Overall, 14 out of 42 patients who underwent radiographic assessment showed progression of osteoarthritis changes at the final followup after the intervention.Conclusion:In our study, there was a statistically significant improvement in the IKDC and Lysholm scores following the intervention. There was a slight deterioration in the scores at the final followup but the overall rate of satisfaction was still high and most of the patients were able to do their routine chores and light exercises suitable for their age group. Around one-third of patients show progression of radiographic changes in the postoperative period and this requires long term evaluation.

Age over 50 years is not a contraindication for anterior cruciate ligament reconstruction

“…Eight papers [7, 12, 17, 22, 27, 44, 52, 57] with a total of 273 patients available at the time of the latest follow‐up reported the IKDC scores, with a mean average of 82.5 (average min 67.8 − max 92.0).…”

“…Manual stability testing was reported in 10 studies [4, 7, 8, 17, 31, 44, 52, 53, 56, 57]; the Lachman test at latest follow‐up was considered positive in 24 out of 264 knees (9.1%), while a “glide” or “clunk” pivot‐shift test was recorded in 13 knees (5.9%).…”

“…Objective stability testing with KT‐1000 arthrometer device or equivalent was performed in seven studies [4, 8, 27, 31, 48, 56, 57]; one study [7] was excluded from this analysis because reporting unilateral maximal tibiofemoral translation. The mean side‐to‐side difference was 2.15 mm (0.2 mm − 2.7 mm).…”

“…The total failure rate, described as reoperation for revision ACL surgery and calculated from the 13 papers [4, 6-8, 17, 22, 27, 31, 44, 52, 53, 56, 57] reporting these data (for a total of 377 knees), was 2.7%, ranging from 0 to 14.3%. The Lysholm score was the most frequently adopted scale, reported in 14 studies [4,7,8,12,17,22,27,31,44,48,50,52,56,57] for a total of 404 patients; the average score was 89.3 (average min 82.9 − max 98.0). papers [7,12,17,22,27,44,52,57] with a total of 273 patients available at the time of the latest follow-up reported the IKDC scores, with a mean average of 82.5 (average min 67.8 − max 92.0).…”

“…The Lysholm score was the most frequently adopted scale, reported in 14 studies [4,7,8,12,17,22,27,31,44,48,50,52,56,57] for a total of 404 patients; the average score was 89.3 (average min 82.9 − max 98.0). papers [7,12,17,22,27,44,52,57] with a total of 273 patients available at the time of the latest follow-up reported the IKDC scores, with a mean average of 82.5 (average min 67.8 − max 92.0).…”