Single- and Double-Bundle Anterior Cruciate Ligament Reconstruction in Patients Aged Over 50 Years

Ventura, Alberto; Legnani, Claudio; Terzaghi, Clara; Borgo, Enrico

doi:10.1016/j.arthro.2012.04.146

Cited by 43 publications

(71 citation statements)

References 23 publications

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“…A comparison of BPTB and hamstring autografts found no significant difference in terms of patients’ satisfaction or clinical outcomes 27. Moreover, double-bundle reconstruction using hamstring autografts showed no clinical difference compared with the single-bundle technique in the middle-aged patient 29. However, second-look arthroscopy within 2 years of double-bundle ACL reconstruction showed significantly poorer synovial coverage of ACL grafts in patients older than 50 years compared with younger patients.…”

Section: Discussionmentioning

confidence: 97%

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

et al. 2017

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Section: Discussionmentioning

confidence: 97%

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

et al. 2017

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“…2,4,7,18 Few studies have evaluated outcomes after ACL reconstruction in patients 50 years and older. 3,9,13,22,29,30 Blyth et al 3 reported improved outcomes in patients older than 50 years after ACL reconstruction with a follow-up of 2 to 8 years. The Lysholm score improved from 63 to 93, Cincinnati score from 49 to 89, Tegner activity scale from 3.7 to 5.2, and the IKDC score was normal or nearly normal in 25 knees (81%).…”

Section: Discussionmentioning

confidence: 99%

“…Both the cutoff age for ACL reconstruction and the treatment of ACL tears in patients older than 50 years are controversial. While studies have investigated ACL reconstruction in patients older than 50, 3,9,13,30 to our knowledge no study has compared outcomes between a control group of young patients and patients aged 50 years and older. Therefore, the purpose of this study was to compare the clinical outcomes and failure rates in patients aged 20 to 30 years with those of patients aged 50 to 75 years at the time of primary ACL reconstruction.…”

mentioning

confidence: 99%

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

Cinque

Chahla

Moatshe

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Until recently, anterior cruciate ligament (ACL) tears in older patients were treated conservatively; however, these patients often experienced significant pain and instability.Purpose/Hypothesis:The purpose of this study was to compare the patient-reported outcomes, patient satisfaction, and failure rates of primary ACL reconstruction between a younger (age 20-30 years) and older (age 50-75 years) patient cohort. It was hypothesized that patients in the older cohort could achieve comparable clinical outcomes and retear rates following ACL reconstruction with a bone-tendon-bone autograft or allograft compared with the younger patients.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective analysis of prospectively collected data was performed. All patients undergoing a primary ACL reconstruction between 2010 and 2014 by a single surgeon were collated. Patients were divided into 2 groups based on age at the time of surgery: a younger cohort (20-30 years) and an older cohort (50-75 years). Patients were excluded if they were outside the desired age intervals; had revision ACL reconstructions; had a previous intra-articular infection in the ipsilateral knee; underwent prior alignment correction procedure, cartilage repair, or transplant procedure; had a concurrent posterior cruciate ligament tear; received meniscal allograft transplant; or had an intra-articular fracture. Subjective outcome scores (Tegner activity scale, Lysholm, International Knee Documentation Committee [IKDC], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], Short Form–12 [SF-12] mental health component summary [MCS], and SF-12 physical component summary [PCS]), retear rate, and rate of secondary arthrofibrosis surgery were documented at a minimum 2-year follow-up and were compared between groups.Results:A total of 85 patients met the inclusion criteria for this study: 52 patients (33 males, 19 females) in the younger cohort and 33 patients (14 males, 19 females) in the older cohort. No significant differences were found in any demographic factor except for age. Significant improvement in outcome scores from pre- to postoperative assessments was found in both groups. The younger cohort had significantly lower postoperative WOMAC scores (P = .025). However, no significant differences were found between the younger and older cohorts in postoperative SF-12 PCS (P = .487), SF-12 MCS (P = .900), Lysholm score (P = .660), IKDC score (P = .256), Tegner activity score (P = .420), or patient satisfaction (P = .060). Within the older cohort, increasing age did not correlate with inferior postoperative outcome scores. Furthermore, no retears occurred in either group, and the rates of arthrofibrosis surgery were comparable (12% older cohort vs 13% younger cohort).Conclusion:Improved function and satisfaction, comparable to the younger age group, were achieved in patients older than 50 years undergoing ACL reconstruction. Furthermore, low failure rates can be achieved in both younger and older patients underg...

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“…Trials comparing osteoarthritis after double bundle versus single bundle ACL reconstruction are limited but increasing in number given the superior rotational control after double bundle reconstruction which may better restore knee rotational kinematics during functional activity [ 7 ]. However, Ventura et al [ 80 ] retrospectively compared 36 patients who underwent single bundle reconstruction to 14 patients who underwent double bundle reconstruction and reported no difference in the rate of radiological osteoarthritic changes at a mean of 4.4 years postoperatively. The results from Suomalainen et al [ 81 ] were similar in their prospective study of 90 patients at 5-year follow-up.…”

Section: Knee-related Risk Factorsmentioning

confidence: 99%

The Relationship between Anterior Cruciate Ligament Injury and Osteoarthritis of the Knee

Simon

Mascarenhas

Saltzman

et al. 2015

Advances in Orthopedics

119

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Anterior cruciate ligament (ACL) tears are a common injury, particularly in the athletic and youth populations. The known association between ACL injury and subsequent osteoarthritis (OA) of the knee merits a more in-depth understanding of the relationship between the ACL-injured knee and osteoarthritis. ACL injury, especially with concomitant meniscal or other ligamentous pathology, predisposes the knee to an increased risk of osteoarthritis. ACL insufficiency results in deterioration of the normal physiologic knee bending culminating in increased anterior tibial translation and increased internal tibial rotation. This leads to increased mean contact stresses in the posterior medial and lateral compartments under anterior and rotational loading. However, surgical reconstruction of the ACL has not been shown to reduce the risk of future OA development back to baseline and has variability based on operative factors of graft choice, timing of surgery, presence of meniscal and chondral abnormalities, and surgical technique. Known strategies to prevent OA development are applicable to patients with ACL deficiency or after ACL reconstruction and include weight management, avoidance of excessive musculoskeletal loading, and strength training. Reconstruction of the ACL does not necessarily prevent osteoarthritis in many of these patients and may depend on several external variables.

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Single- and Double-Bundle Anterior Cruciate Ligament Reconstruction in Patients Aged Over 50 Years

Cited by 43 publications

References 23 publications

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

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

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

The Relationship between Anterior Cruciate Ligament Injury and Osteoarthritis of the Knee

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