Reconstruction of the anterior cruciate ligament in patients over 50 years

Abstract

The records of patients aged 50 years or over who underwent primary reconstruction of the anterior cruciate ligament between 1990 and 2002 were reviewed. There were 35 knees in 34 patients that met the inclusion criteria. The mean age of the patients was 57 years (50 to 66) and the mean clinical follow-up was for 72 months (25 to 173). A total of 23 knees were reconstructed with patellar tendon allograft, and 12 with patellar tendon autograft. The mean pre-operative knee extension was 1 degrees (-5 degrees to 10 degrees) and flexion was 129 degrees (125 degrees to 150 degrees) and at follow-up these values were 0 degrees (-5 degrees to 5 degrees) and 135 degrees (120 degrees to 150 degrees), respectively. Pre-operatively there were 31 knees (89%) with a Lachman grade 2+ or 3+. Post-operatively, 33 knees (94%) were Lachman grade 0 or 1+. The mean pre- and post-operative International Knee Documentation Committee scores were 39 (23 to 72) and 90 (33 to 100) respectively. The mean pre- and post-operative Lysholm scores were 50 (18 to 68) and 92 (28 to 100) respectively and the mean University of California Los Angeles activity scores were 8.5 before injury (4 to 10), 4.3 (3 to 6) after injury and 8.3 (4 to 10) post-operatively. There were three graft failures (8.6%) requiring revision. We conclude that reconstruction of the anterior cruciate ligament in carefully-selected patients aged 50 years or over can achieve similar results to those in younger patients, with no increased risk of complications.

Management of anterior cruciate ligament rupture in patients aged 40 years and older

“…Ten studies [15, 19–21, 26–31] used the Tegner activity score to evaluate the levels of activity. In all cases, ACL reconstruction produced average or satisfactory results, with scores ranging from 4.1 to 6.6.…”

“…In one paper, the Telos stress system (Metax GmbH, Marburg, Germany) was used [32]. Two studies reported the results of Lachman and pivot-shift tests [27, 31]. All reports showed an improvement in mean residual differential laxity.…”

Anterior Cruciate Ligament Reconstruction Improves Activity-Induced Pain in Comparison With Pain at Rest in Middle-Aged Patients With Significant Cartilage Degeneration

“…4,6,16 Recent reports revealed that the outcomes of ACL reconstruction in middle-aged patients were satisfactory and comparable with those of young patients. [1][2][3]5,8,11 Furthermore, even in the ACL-deficient knee with concomitant advanced cartilage degeneration or in the symptomatic arthritic knee, ACL reconstruction could yield satisfactory results, including symptomatic improvement, decreased instability, and restoration of daily activity. 12,15 However, even with similar levels of cartilage degeneration or arthritic change, the symptomatic manifestations vary by individual.…”

Assessing activity participation in the ACL injured population: a systematic review of activity rating scale measurement properties

“…Twenty-five authors used their own scales with no reference to validation of psychometric properties. The Marshall score was used in three studies 34,55,56 and the University of California activity scale in one 57 with no cited validation.…”