High rate of return to activity after ACL reconstruction in patients over 40 years of age: a systematic review

Wierer, Guido; Herbst, Elmar; Hoser, Christian; Gföller, Peter; Fink, Christian

doi:10.1136/jisakos-2016-000085

Cited by 3 publications

(5 citation statements)

References 41 publications

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“…In the current study, after ACL reconstruction the mean Tegner activity score reached to pre-injury level. Previous studies have also shown improvement in Tegner activity after ACL reconstruction [23,30,32]. The findings of the previous studies are comparable to the present study.…”

Section: Discussionsupporting

confidence: 91%

“…While conservative treatment is associated with satisfactory results in less active older patients, there is an increased risk of residual instability, and associated chondral and meniscal injuries in highly active patients [ 3 , 8 ]. Additionally, these older active patients frequently desire to return to their pre-injury level of function and specific sport participation [ 16 , 18 , 30 ]. Therefore, to maintain an active lifestyle and prevent decreased knee function, ACL reconstruction is being increasingly used in active patients [ 27 , 29 ].…”

Section: Introductionmentioning

confidence: 99%

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Quadriceps autograft is a viable graft choice for arthroscopic ACL reconstruction in patients over 50 years of age

Meena

Farinelli

Hoser

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to evaluate the patient-reported outcomes, graft failure, quadriceps rupture and sports preference after arthroscopic ACL reconstruction in patients older than 50 years who underwent arthroscopic ACL reconstruction with a quadriceps tendon (QT) autograft. Methods Between 2010 and 2020, prospectively collected data were obtained from an institutional database. Patients older than 50 years with primary arthroscopic ACL reconstruction and a minimum of 2 years of follow-up were included. Patients undergoing a revision ACL reconstruction or undergoing a primary ACL reconstruction using a graft other than a QT autograft, and patients with a contralateral knee injury or osteoarthritis (Ahlbäck stage 2 or higher) were excluded. A minimally invasive technique was used for QT autograft harvesting. Patients were evaluated for pre-injury and 2-year follow-up Lysholm knee score, Tegner activity level, Visual Analog Scale (VAS) for pain, graft failure, quadriceps tendon rupture, and return to sport. Results A total of 57 patients were included in the study. The mean age of the cohort was 54.9 ± 5.2 (range 50–75). Of the 57 reconstructions, 16 (28%) were isolated ACL reconstructions, while 41 (72%) were complex reconstructions (concomitant meniscus, cartilage and/or collateral ligament injuries). At the 2-year follow-up Lysholm knee score, Tegner activity level and VAS for pain improved to pre-injury level and no significant difference was noted between pre-injury and 2-year follow-up functional scores (n.s.). No case of graft failure or quadriceps tendon rupture was reported. No significant difference was noted in the pre-injury and postoperative sports preference (n.s.) and all patients return to their desired sports activity. Conclusion Arthroscopic ACL reconstruction by using QT autograft in highly active older patients provides satisfactory patient-reported functional outcomes and allows recovery of the pre-injury level of activity. QT autograft is a good graft option in patients older than 50 years. Level of evidence Level IV.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Quadriceps autograft is a viable graft choice for arthroscopic ACL reconstruction in patients over 50 years of age

Meena

Farinelli

Hoser

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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View full text Add to dashboard Cite

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“…Systematic reviews examining functional and subjective results of ACL reconstruction in older age cohorts reflect overwhelmingly good outcomes. 1,7,21,35…”

Section: Discussionmentioning

confidence: 99%

“…Systematic reviews examining functional and subjective results of ACL reconstruction in older age cohorts reflect overwhelmingly good outcomes. 1,7,21,35 As surgeons continue to offer ACL reconstruction to patients in this older age group, good data are needed to counsel patients regarding if and when to undergo reconstruction. From a functional perspective, older patients do well, with results comparable with those of younger cohorts.…”

Section: Discussionmentioning

confidence: 99%

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Delayed ACL Reconstruction in Patients ≥40 Years of Age Is Associated With Increased Risk of Medial Meniscal Injury at 1 Year

et al. 2019

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Background: Anterior cruciate ligament (ACL) tears in the pediatric and young adult ACL-deficient knee are often associated with meniscal or chondral injury with delayed time to surgery. The incidence of ACL reconstruction performed in patients aged ≥40 years is rising, and it is unclear if delayed surgery in this cohort similarly affects the health of the meniscus and cartilage. Purpose: To evaluate whether delayed reconstruction in a cohort of patients aged ≥40 years is associated with an increased risk of meniscal or chondral injury. Study Design: Cohort study; Level of evidence, 3. Methods: Records of patients aged ≥40 years who underwent primary arthroscopic ACL reconstruction between 2012 and 2016 at an academic hospital were retrospectively reviewed. Patient characteristic data and time to surgery were recorded. Operative reports were analyzed for meniscal and chondral injuries as well as treatment. Patients were grouped according to time to surgery, defined as early (<90 days) or delayed (≥90 days). Logistic regression modeling was used to form associations between elapsed time to surgery and patient characteristics to meniscal and chondral damage. Additionally, risks for meniscal and chondral injury were analyzed at time points of 180 days and 1 year from injury to surgery. Results: A total of 227 patients met the study criteria: 106 patients underwent early surgery, and 121 underwent delayed surgery. The authors identified 127 medial meniscal tears and 106 lateral meniscal tears. Medial, lateral, and patellofemoral compartment chondral injury was reported in 127, 82, and 130 patients, respectively. Delayed surgery (≥90 days) was not associated with increased risk of medial or lateral meniscal tears or any chondral injury at 90 days. Each year of increased age was associated with an increased odds ratio: 1.09 ( P = .001) for medial meniscal tears, 1.06 ( P = .014) for lateral meniscal tears, 1.10 ( P = .001) for medial compartment chondral injuries, and 1.07 ( P = .007) for patellofemoral compartment chondral injuries. Additionally, each unit of increased body mass index was associated with an increased odds ratio: 1.09 ( P = .039) for medial meniscal tears and 1.14 ( P = .003) for medial compartment cartilage injury. Analysis of 180-day and 1-year time points revealed an increased risk (odds ratio, 3.47; 95% CI, 1.55-7.77; P = .002) for medial meniscal injury when surgery was delayed for >1 year. Conclusion: Delayed ACL reconstruction (≥90 days) among patients aged ≥40 years was not associated with an increased risk of meniscal or chondral injury. Increasing age and body mass index were associated with higher risks of meniscal and chondral injuries in this cohort. Delay in surgery for >1 year was associated with increased risk of medial meniscal tear.

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Both Hamstring and Quadriceps Tendon Autografts Offer Similar Functional Outcomes After Arthroscopic Anterior Cruciate Ligament Reconstruction in Patients Aged 50 Years or Older

Meena,

Farinelli,

D’Ambrosi

et al. 2024

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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High rate of return to activity after ACL reconstruction in patients over 40 years of age: a systematic review

Cited by 3 publications

References 41 publications

Quadriceps autograft is a viable graft choice for arthroscopic ACL reconstruction in patients over 50 years of age

Quadriceps autograft is a viable graft choice for arthroscopic ACL reconstruction in patients over 50 years of age

Delayed ACL Reconstruction in Patients ≥40 Years of Age Is Associated With Increased Risk of Medial Meniscal Injury at 1 Year

Both Hamstring and Quadriceps Tendon Autografts Offer Similar Functional Outcomes After Arthroscopic Anterior Cruciate Ligament Reconstruction in Patients Aged 50 Years or Older

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