ACL reconstruction in over-50 year-olds: Comparative study between prospective series of over-50 year-old and under-40 year-old patients

Panisset, Jean-Claude; Gonzalez, Jean-François; Lavigne, C. de; Ode, Quentin; Dejour, David; Ehlinger, Matthieu; Fayard, Jean-Marie; Lustig, Sébastien

doi:10.1016/j.otsr.2019.09.009

Cited by 22 publications

(25 citation statements)

References 18 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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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

Sylvia

Gill²,

Engler

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To evaluate patient-reported outcomes in patients aged 50 years and older undergoing anterior cruciate ligament reconstruction (ACLR) using bone–patellar tendon–bone (BPTB) allograft with minimum 2-year follow-up. Methods A retrospective review was performed on a consecutive series of patients aged 50 and older who underwent ACLR using BPTB allograft by a single surgeon with minimum 2-year follow-up. Postoperative International Knee Documentation Committee (IKDC), Lysholm, and Physical Component Summary of the 12-item Short-Form Health Survey were used to assess outcomes, as well as preoperative and postoperative Tegner activity scores, which were compared using a paired sample t test. Results Fifty patients met inclusion criteria, with a mean age of 55.3 ± 4.4 years and mean follow-up of 4.8 ± 1.9 years. Tegner activity scores improved from a mean preoperative score of 3.26 to a mean postoperative score of 5.25 ( P < .001). The mean postoperative scores for Lysholm, IKDC, and Physical Component Summary were 87.3, 81.1, and 54.3, respectively. In total, 36 (72%) patients achieved a patient acceptable symptom state score for IKDC and 37 (74%) patients achieved a minimal clinically important difference for Tegner activity score. Thirty-eight (76%) patients reported good-to-excellent results, 6 (12%) patients reported fair results, and 6 (12%) patients reported poor results. Conclusions ACLR with BPTB allograft in patients aged 50 and older leads to good patient-reported outcomes with significantly increased postoperative activity status at a minimum 2-year follow-up. Level of Evidence Level IV, therapeutic case series.

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Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Sylvia

Gill²,

Engler

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

View full text Add to dashboard Cite

show abstract

“…Since there are limited studies reporting the normal and 1-year recovery phase values of muscle strengths and hop performances in patients aged !25 years, it is questionable whether our results are outliers. Although several studies have reported satisfactory clinical outcomes after ACLR in older patients, 14,23 different rehabilitation strategies and time frames may be required in older patients.…”

Section: Discussionmentioning

confidence: 99%

Low Rate of Return to Preinjury Tegner Activity Level Among Recreational Athletes: Results at 1 Year After Primary ACL Reconstruction

Kim¹,

Lee

Kim

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: There is limited information about the functional recovery and rate of return to preinjury levels of sports among recreational athletes after anterior cruciate ligament reconstruction (ACLR). Purpose: To investigate the recovery of quadriceps or hamstring strength, assess functional performance, and determine the rate of return to preinjury sports levels among recreational athletes at 1 year after ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 91 recreational-level athletes who underwent anatomic single-bundle ACLR were enrolled. We evaluated the limb symmetry index (LSI) of the quadriceps and hamstring peak torque strength at 60°, in addition to hop test performance (single-leg, triple, crossover, and 6-m timed), patient-reported outcomes, and pre- versus postoperative Tegner activity levels. Outcomes were compared between younger (age <25 years) and older patients (age ≥25 years). Results: There were 48 patients in the younger group and 43 patients in the older group. At 1-year follow-up, the overall LSIs for quadriceps strength and hamstring strength were 77% and 86%, respectively, and the LSIs of the hop tests were 79% for single-leg, 81% for triple, 84% for crossover, and 85% for 6-m timed hop. Overall, only 24% patients returned to their preinjury Tegner level, and only 8% of patients met the criteria for return to pivoting, cutting, and jumping sports. At 1-year follow-up, the younger group showed significantly more quadriceps strength than the older group (85% vs 64%; P = .0001), better single, triple, crossover, and 6-m timed hop test results (85% vs 69%, P = .003; 84% vs 75%, P = .046; 91% vs. 74%, P < .001; and 91% vs 76%, P = .003, respectively), higher Lysholm score (87 vs 74; P < 0.001) and International Knee Document Committee score (82 vs 66; P < .001), and a higher rate of return to preinjury Tegner level (35% vs 12%; P = .009). Conclusion: Only 24% of patients returned to the preinjury Tegner level at 1 year after ACLR (35% younger group vs 12% older group; P = .009). This information might be helpful in setting realistic expectations for recreational athletes after surgery.

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“…Depending on several factors like the severity of ACL injury, the number, type, and severity of concomitant knee injuries, different surgery techniques have been considered [ 13 , 16 ]. In case of a high-grade partial or subtotal tear of the ACL, an acute biologic approach was used to preserve the native ACL.…”

Section: Methodsmentioning

confidence: 99%

Ski-geometric parameters do not differ between ACL injury mechanisms in recreational alpine skiing

Posch

Ruedl

Greier

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose It is not known so far if ski-equipment-related factors differ between the ACL injury mechanisms, potentially influencing the circumstances and causes of falling, finally resulting in ACL injury. More specifically focusing on the injury mechanisms will provide a deeper understanding of injury causation. The aim of the study was to evaluate whether ACL injury mechanisms in recreational alpine skiing differ with regard to ski-geometric parameters, self-reported circumstances and causes of accident and injury severity. Methods Among a cohort of 392 ACL-injured (57.9% females) skiers, age, sex, height, weight, skill level, risk-taking behavior, circumstances and causes of accident, and ACL injury severity were collected by questionnaire. Additionally, patients had to recall their type of fall (ACL injury mechanism) by classifying forward and backward falls with and without body rotation. Ski length, side cut radius and widths of the tip, waist and tail were directly notated from the ski. Results The forward fall with body rotation was the most common reported ACL injury mechanism (63%). A riskier behavior was associated with forward falls without body rotation. Ski-geometric parameters did not significantly influence the type of ACL injury mechanism. Regarding accident characteristics, catching an edge of the ski was more frequent (p < 0.001) the cause for forward falls (75% and 67%) when compared to the backward falls (46 and 15%) and executing a turn was the most frequent action in all falls (39–68%). A complete rupture of the ACL (66–70%) was more commonly reported than a partial tear (30–34%) among all four non-contact ACL injury mechanisms (n.s.). Conclusion In contrast to risk-taking behavior and accident characteristics, ski-geometric parameters and injury severity do not significantly differ between ACL injury mechanisms in recreational skiing. Thus, an individual skiing style seems to have more impact on ACL injury mechanisms than ski equipment. Future studies should evaluate potential effects of ski geometry on the incidence of ACL injury. Level of evidence III.

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ACL reconstruction in over-50 year-olds: Comparative study between prospective series of over-50 year-old and under-40 year-old patients

Cited by 22 publications

References 18 publications

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

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

Low Rate of Return to Preinjury Tegner Activity Level Among Recreational Athletes: Results at 1 Year After Primary ACL Reconstruction

Ski-geometric parameters do not differ between ACL injury mechanisms in recreational alpine skiing

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