Patients older than 50 years had similar results of knee strength and anteroposterior stability after ACL reconstruction compared to younger patients

  • Do Kyung Kim
  • Geon Park
  • Liang-Tseng KuoEmail author
  • Won Hah ParkEmail author



To evaluate knee strength, ligament stability, and functional outcomes in patients older than 50 years who underwent anterior cruciate ligament (ACL) reconstruction, and to compare these results with those obtained from a younger patient group (< 40 years).


Forty patients older than 50 years and 50 patients younger than 40 years who underwent ACL reconstruction were retrospectively studied. Isokinetic extensor and flexor muscle strength were evaluated. The peak torque was determined at speeds of 60°/s and 180°/s. The highest peak torque at each velocity was compared with that on the uninjured side. Patients were also evaluated for knee anteroposterior (AP) laxity and functional outcomes, which were measured by the Lysholm and International Knee Documentation Committee (IKDC) scores. All tests were evaluated at baseline and 1 year postoperatively.


The groups were comparable at the baseline. Both groups had significant improvements in all parameters, including isokinetic muscle strength, AP laxity, and functional scores, at 1 year postoperatively (all p < 0.05). Compared with younger patients, older patients had similar results for extensor and flexor strength, AP laxity, and Lysholm score (n.s.). However, younger patients had better IKDC scores than did older patients [median 81.1; 95% confidence interval (CI) 95% CI 78.9–88.7 vs. median 75.6; 95% CI 70.1–79.3, p = 0.007].


Though with lower IKDC scores, older patients with ACL reconstruction had comparable results of knee strength and ligament laxity to younger patients. ACL reconstruction is recommended for treating patients older than 50 years with ACL insufficiency, especially for those with high functional demand.

Level of evidence

Retrospective cohort study, III.


Anterior cruciate ligament reconstruction Muscle strength measurement Knee laxity Older patients 



Anterior cruciate ligament




International Knee Documentation Committee


Maximal manual test






Author contributions

DKK and WHP were responsible for the study concept and design. DKK and GP conducted this study and collected data. DKK and L-TK participated in the analysis and interpretation of the data. DKK, GP, and L-TK drafted the manuscript. L-TK and WHP critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript.



Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

167_2018_5342_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 15 KB)


  1. 1.
    Anderson AF, Snyder RB, Lipscomb AB Jr (2001) Anterior cruciate ligament reconstruction. A prospective randomized study of three surgical methods. Am J Sports Med 29(3):272–279CrossRefGoogle Scholar
  2. 2.
    Barber FA, Aziz-Jacobo J, Oro FB (2010) Anterior cruciate ligament reconstruction using patellar tendon allograft: an age-dependent outcome evaluation. Arthroscopy 26(4):488–493CrossRefGoogle Scholar
  3. 3.
    Blyth MJ, Gosal HS, Peake WM, Bartlett RJ (2003) Anterior cruciate ligament reconstruction in patients over the age of 50 years: 2- to 8-year follow-up. Knee Surg Sports Traumatol Arthrosc 11(4):204–211CrossRefGoogle Scholar
  4. 4.
    Buss DD, Min R, Skyhar M, Galinat B, Warren RF, Wickiewicz TL (1995) Nonoperative treatment of acute anterior cruciate ligament injuries in a selected group of patients. Am J Sports Med 23(2):160–165CrossRefGoogle Scholar
  5. 5.
    Chaory K, Poiraudeau S (2004) Rating scores for ACL ligamentoplasty. Ann Readapt Med Phys 47(6):309–316CrossRefGoogle Scholar
  6. 6.
    Cinque ME, Chahla J, Moatshe G, DePhillipo NN, Kennedy NI, Godin JA et al (2017) Outcomes and complication rates after primary anterior cruciate ligament reconstruction are similar in younger and older patients. Orthop J Sports Med 5(10):2325967117729659. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Conteduca F, Caperna L, Ferretti A, Iorio R, Civitenga C, Ponzo A (2013) Knee stability after anterior cruciate ligament reconstruction in patients older than forty years: comparison between different age groups. Int Orthop 37(11):2265–2269CrossRefGoogle Scholar
  8. 8.
    Dahm DL, Wulf CA, Dajani KA, Dobbs RE, Levy BA, Stuart MA (2008) Reconstruction of the anterior cruciate ligament in patients over 50 years. J Bone Jt Surg Br 90(11):1446–1450CrossRefGoogle Scholar
  9. 9.
    de Jong SN, van Caspel DR, van Haeff MJ, Saris DB (2007) Functional assessment and muscle strength before and after reconstruction of chronic anterior cruciate ligament lesions. Arthroscopy 23(1):21–28 (8.e1–3) PubMedGoogle Scholar
  10. 10.
    Fu FH, Bennett CH, Lattermann C, Ma CB (1999) Current trends in anterior cruciate ligament reconstruction. Part 1: biology and biomechanics of reconstruction. Am J Sports Med 27(6):821–830CrossRefGoogle Scholar
  11. 11.
    Gifstad T, Drogset JO, Viset A, Grontvedt T, Hortemo GS (2013) Inferior results after revision ACL reconstructions: a comparison with primary ACL reconstructions. Knee Surg Sports Traumatol Arthrosc 21:2011–2018CrossRefGoogle Scholar
  12. 12.
    Iorio R, Iannotti F, Ponzo A, Proietti L, Redler A, Conteduca F, Ferretti A (2018) Anterior cruciate ligament reconstruction in patients older than fifty years: a comparison with a younger age group. Int Orthop 42(5):1043–1049CrossRefGoogle Scholar
  13. 13.
    Keays SL, Bullock-Saxton JE, Newcombe P, Keays AC (2003) The relationship between knee strength and functional stability before and after anterior cruciate ligament reconstruction. J Orthop Res 21(2):231–237CrossRefGoogle Scholar
  14. 14.
    Kim DK, Hwang JH, Park WH (2015) Effects of 4 weeks preoperative exercise on knee extensor strength after anterior cruciate ligament reconstruction. J Phys Ther Sci 27(9):2693–2696CrossRefGoogle Scholar
  15. 15.
    Kim DK, Park G, Kadir KBHMS, Kuo LT, Park WH (2018) Comparison of knee stability, strength deficits, and functional score in primary and revision anterior cruciate ligament reconstructed knees. Sci Rep 8(1):9186. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kim KT, Kim HJ, Lee HI, Park YJ, Kang DG, Yoo JI, Moon DK, Cho SH, Hwang SC (2018) A comparison of results after anterior cruciate ligament reconstruction in over 40 and under 40 years of age: a meta-analysis. Knee Surg Relat Res 30(2):95–106CrossRefGoogle Scholar
  17. 17.
    Lepley LK, Palmieri-Smith RM (2015) Quadriceps strength, muscle activation failure, and patient-reported function at the time of return to activity in patients following anterior cruciate ligament reconstruction: a cross-sectional study. J Orthop Sports Phys Ther 45(12):1017–1025CrossRefGoogle Scholar
  18. 18.
    Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10(3):150–154CrossRefGoogle Scholar
  19. 19.
    Mall NA, Frank RM, Saltzman BM, Cole BJ, Bach BR Jr (2016) Results after anterior cruciate ligament reconstruction in patients older than 40 years: how do they compare with younger patients? a systematic review and comparison with younger populations. Sports Health 8(2):177–181CrossRefGoogle Scholar
  20. 20.
    Ministry of Culture, Sport and Tourism (2016) Survey on citizen’s sports participation. Sejong (Korea): Ministry of Culture, Sports and Tourism. Accessed 21 June 2018
  21. 21.
    Myer GD, Ford KR, Barber Foss KD, Liu C, Nick TG, Hewett TE (2009) The relationship of hamstrings and quadriceps strength to anterior cruciate ligament injury in female athletes. Clin J Sport Med 19(1):3–8CrossRefGoogle Scholar
  22. 22.
    Osti L, Papalia R, Del Buono A, Leonardi F, Denaro V, Maffulli N (2011) Surgery for ACL deficiency in patients over 50. Knee Surg Sports Traumatol Arthrosc 19(3):412–417CrossRefGoogle Scholar
  23. 23.
    Palmieri-Smith RM, Thomas AC, Wojtys EM (2008) Maximizing quadriceps strength after ACL reconstruction. Clin Sports Med 27(3):405–424CrossRefGoogle Scholar
  24. 24.
    Seng K, Appleby D, Lubowitz JH (2008) Operative versus nonoperative treatment of anterior cruciate ligament rupture in patients aged 40 years or older: an expected-value decision analysis. Arthroscopy 24(8):914–920CrossRefGoogle Scholar
  25. 25.
    Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49Google Scholar
  26. 26.
    Toanen C, Demey G, Ntagiopoulos PG, Ferrua P, Dejour D (2017) Is there any benefit in anterior cruciate ligament reconstruction in patients older than 60 years? Am J Sports Med 45(4):832–837CrossRefGoogle Scholar
  27. 27.
    Toonstra J, Mattacola CG (2013) Test-retest reliability and validity of isometric knee-flexion and -extension measurement using 3 methods of assessing muscle strength. J Sport Rehabil. CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Sports Medicine CenterSamsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
  2. 2.Department of Orthopaedic Surgery and Sports Medicine CenterChang Gung Memorial HospitalPutz CityTaiwan

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