Results After Anterior Cruciate Ligament Reconstruction in Patients Older Than 40 Years

Abstract

Context:Anterior cruciate ligament (ACL) reconstruction in older patients is a controversial topic among orthopaedic surgeons.Objective:To determine the outcomes, failure, and morbidity associated with ACL reconstruction in patients older than 40 years and to compare it with nonoperative treatment as well as results of ACL reconstruction in a younger patient population.Data Sources:A systematic review of the literature from 1970 to 2015 was conducted utilizing MEDLINE, CINAHL, and the Cochrane Central Register databases using PRISMA guidelines.Study Selection:Inclusion criteria were studies with longer than 2-year follow-up of primary ACL reconstruction and minimum age of patients older than 40 years, inclusive of any graft type or source and of any concomitant meniscal pathology.Study Design:Systematic review.Level of Evidence:Level 4.Data Extraction:Two independent reviewers collected demographic, preoperative, intraoperative, and postoperative data.Results:Twelve studies with a total of 452 patients were included. The mean patient age was 47.8 years (range, 40-66 years) with a mean follow-up of 53.3 months (minimum, 24 months). Lysholm scores improved from 53.9 to 90.5 in the 11 operative studies. The only nonoperative study reported a mean Lysholm score of 82 after rehabilitation. International Knee Documentation Committee (IKDC) scores of A or B were found in 81%. Tegner activity scores averaged 4.7 preinjury, fell to 2.9 preoperatively, and returned to 4.7 postoperatively. The reported failure rate was 2.3%. There were few complications, and failure rate was similar in younger patients.Conclusion:The data confirm that ACL reconstruction can be recommended to patients older than 40 years who wish to maintain an active lifestyle or have symptomatic instability with daily activities. Patient-based outcomes scores were better in the operative studies compared with the single nonoperative study in this patient population.

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

“…Historically, ACL reconstruction has been recommended for the young, active population with symptomatic ACL tears. Other authors 19,25 have advocated for ACL reconstruction to prevent meniscal and cartilage injuries in chronically unstable knees, both of which are associated with poor function and rapid progression of knee degenerative changes. The treatment of ACL tears in the elderly population is still controversial.…”

“…19 Moreover, ACL reconstruction has been demonstrated to result in greater improvements in quality-adjusted life-years at a lower cost compared with nonoperative intervention. 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.…”

Effects of Preserving Anatomically Positioned and Adequate Remnant ACL Tissue in Double-Bundle ACL Reconstruction

“… 10 , 18 Nishio et al 37 reported that equivalent clinical outcomes (Lysholm and IKDC scores) were observed between 2 age groups (patients ≥40 and <40 years of age) after DB-ACLR. Mall et al 31 reported a systematic review of the results of single-bundle ACLR in patients aged >40 years. They reported that the outcomes were similar to those in younger patients.…”

Functional Outcomes and Hop Tests Results in Anterior Cruciate Ligament Reconstruction Patients with Adjustable Loop Fixation: 2-Years Follow-up

“…The most common knee surgery is anterior cruciate ligament (ACL) reconstruction. It produces early return to sport and good clinical outcomes [1], [2], [3], [4], [5], [6], [7]. The outcomes are affected by various factors, such as type of grafts, graft fixation methods, tunnel orientations, graft diameters, and rehabilitation program.…”