Advertisement

International Orthopaedics

, Volume 42, Issue 5, pp 1043–1049 | Cite as

Anterior cruciate ligament reconstruction in patients older than fifty years: a comparison with a younger age group

  • Raffaele Iorio
  • Ferdinando Iannotti
  • Antonio Ponzo
  • Lorenzo Proietti
  • Andrea Redler
  • Fabio Conteduca
  • Andrea Ferretti
Original Paper

Abstract

Purpose

To evaluate functional and radiological results in patients older than 50 years who underwent an anatomic anterior cruciate ligament (ACL) reconstruction with semitendinosus and gracilis tendons and to compare these results with those of patients younger than 40 years.

Methods

Thirty-six patients over the age of 50 years with a diagnosis of ACL complete lesion and 36 consecutive patients under 40 years were included in this prospective study. Follow-up included clinical evaluation using Lysholm, IKDC, and Tegner scores and a KT-1000 arthrometric evaluation. Bilateral weight-bearing radiographs were obtained before surgery and at final follow-up of five years to evaluate the degree of osteoarthritis. All patients were evaluated at a one year follow-up (T1) (range 13–17 months) and at final follow-up (T2) (range 60–72 months).

Results

No statistically significant difference was found between the two groups at the subjective and objective evaluations. At a KT-1000 arthrometric evaluation, the mean side to side maximum manual difference was 1.6 mm in the over 50 (group I) and 2.7 mm in the under 40 (group II) (p = 0.009). At 30 lb, the mean side to side difference was 1.7 mm in the over 50 group and 2.6 mm in the under 40 group (p = 0.040). No statistically significant increase in the degree of osteoarthritis was found at follow-up in the over 50 group.

Conclusions

The results of this study seems to confirm that ACL reconstruction in patients older than 50 years is a safe procedure with good to excellent subjective, objective, and radiological outcomes that are comparable to those for younger patients.

Keywords

Anterior cruciate ligament Volleyball MRI Football 

Notes

Compliance with ethical standards

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

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

References

  1. 1.
    Evans S, Shaginaw J, Bartolozzi A (2014) ACL reconstruction—it’s all about timing. Int J Sports PhysTher 9(2):268–273Google Scholar
  2. 2.
    Ciccotti MG, Lombardo SJ, Nonweiler B, Pink M (1994) Non-operative treatment of ruptures of the anterior cruciate ligament in middle-aged patients. Results after long-term follow-up. J Bone Joint Surg Am 76(9):1315–1321CrossRefPubMedGoogle Scholar
  3. 3.
    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):160–165.  https://doi.org/10.1177/036354659502300206 CrossRefPubMedGoogle Scholar
  4. 4.
    Johnson RJ, Beynnon BD, Nichols CE, Renstrom PA (1992) The treatment of injuries of the anterior cruciate ligament. J Bone Joint Surg Am 74(1):140–151CrossRefPubMedGoogle Scholar
  5. 5.
    Ventura A, Legnani C, Terzaghi C, Borgo E (2012) Single- and double-bundle anterior cruciate ligament reconstruction in patients aged over 50 years. Arthroscopy 28(11):1702–1709.  https://doi.org/10.1016/j.arthro.2012.04.146 CrossRefPubMedGoogle Scholar
  6. 6.
    Fitzgerald GK, Axe MJ, Snyder-Mackler L (2000) A decisionmaking scheme for returning patients to high-level activity with nonoperative treatment after anterior cruciate ligament rupture. Knee Surg Sports Traumatol Arthrosc 8(2):76–82.  https://doi.org/10.1007/s001670050190 CrossRefPubMedGoogle Scholar
  7. 7.
    Strehl A, Eggli S (2007) The value of conservative treatment in ruptures of the anterior cruciate ligament (ACL). J Trauma 62(5):1159–1162.  https://doi.org/10.1097/TA.0b013e31805006e7 CrossRefPubMedGoogle Scholar
  8. 8.
    Conteduca F, Ferretti A, Mariani PP, Puddu G, Perugia L (1991) Chondromalacia and chronic anterior instabilities of the knee. Am J Sports Med 19(2):119–123.  https://doi.org/10.1177/036354659101900205 CrossRefPubMedGoogle Scholar
  9. 9.
    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):821–830.  https://doi.org/10.1177/03635465990270062501 CrossRefPubMedGoogle Scholar
  10. 10.
    Louboutin H, Debarge R, Richou J, Selmi TA, Donell ST, Neyret P, Dubrana F (2009) Osteoarthritis in patients with anterior cruciate ligament rupture: a review of risk factors. Knee 16(4):239–244.  https://doi.org/10.1016/j.knee.2008.11.004 CrossRefPubMedGoogle Scholar
  11. 11.
    Legnani C, Terzaghi C, Borgo E, Ventura A (2011) Management of anterior cruciate ligament rupture in patients aged 40 years and older. J Orthop Traumatol 12(4):177–184.  https://doi.org/10.1007/s10195-011-0167-6 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Barber FA, Elrod BF, McGuire DA, Paulos LE (1996) Is an anterior cruciate ligament reconstruction outcome age dependent? Arthroscopy 12(6):720–725CrossRefPubMedGoogle Scholar
  13. 13.
    Bohnsack M, Ruhmann O, Luck K, Wirth CJ (2002) The influence of age on the outcome of anterior cruciate ligament reconstruction. Z Orthop Ihre Grenzgeb 140(2):194–198.  https://doi.org/10.1055/s-2002-31540. CrossRefPubMedGoogle Scholar
  14. 14.
    Brandsson S, Kartus J, Larsson J, Eriksson BI, Karlsson J (2000) A comparison of results in middle-aged and young patients after anterior cruciate ligament reconstruction. Arthroscopy 16(2):178–182CrossRefPubMedGoogle Scholar
  15. 15.
    Viola R, Vianello R (1999) Intra-articular ACL reconstruction in the over-40-year-old patient. Knee Surg Sports Traumatol Arthrosc 7(1):25–28.  https://doi.org/10.1007/s001670050116. CrossRefPubMedGoogle Scholar
  16. 16.
    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):2265–2269.  https://doi.org/10.1007/s00264-013-2050-y CrossRefPubMedGoogle Scholar
  17. 17.
    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):412–417.  https://doi.org/10.1007/s00167-010-1242-x CrossRefPubMedGoogle Scholar
  18. 18.
    Desai N, Björnsson H, Samuelsson K, Karlsson J, Forssblad M (2014) Outcomes after ACL reconstruction with focus on older patients: results from The Swedish National Anterior Cruciate Ligament Register. Knee Surg Sports Traumatol Arthrosc 22(2):379–386.  https://doi.org/10.1007/s00167-013-2803-6 CrossRefPubMedGoogle Scholar
  19. 19.
    Mall NA, Frank RM, Saltzman BM, Cole BJ, Bach BR (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):177–181.  https://doi.org/10.1177/1941738115622138 CrossRefPubMedGoogle Scholar
  20. 20.
    Blyth MJ, Gosal HS, Peake WM, Bartlett RJ (2003) Anterior cruciate ligament reconstruction in patients over the age of 50 years: 2-8 year follow-up. Knee Surg Sports Traumatol Arthrosc 11:204–211CrossRefPubMedGoogle Scholar
  21. 21.
    Baker CL Jr, Jones JC, Zhang J (2014) Long-term outcomes after anterior cruciate ligament reconstruction in patients 60 years and older. Orthop J Sports Med 2(12):2325967114561737.  https://doi.org/10.1177/2325967114561737 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg Br 43-B:752–757CrossRefPubMedGoogle Scholar
  23. 23.
    Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res (198):43–49Google Scholar
  24. 24.
    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):150–154.  https://doi.org/10.1177/036354658201000306 CrossRefPubMedGoogle Scholar
  25. 25.
    Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1(3–4):226–234CrossRefPubMedGoogle Scholar
  26. 26.
    Fairbank TJ (1948) Knee joint changes after meniscectomy. J Bone Joint Surg Br 30B(4):664–670CrossRefPubMedGoogle Scholar
  27. 27.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    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):204–211.  https://doi.org/10.1007/s00167-003-0368-5 CrossRefPubMedGoogle Scholar
  29. 29.
    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 Joint Surg Br. 90(11):1446–1450.  https://doi.org/10.1302/0301-620X.90B11.21210 CrossRefPubMedGoogle Scholar
  30. 30.
    Stein DA, Brown H, Bartolozzi AR (2006) Age and ACL reconstruction revisited. Orthopedics 29(6):533–536PubMedGoogle Scholar
  31. 31.
    Noyes FR, Barber-Westin SD (1997) Arthroscopic-assisted allograft anterior cruciate ligament reconstruction in patients with symptomatic arthrosis. Arthroscopy 13(1):24–32CrossRefPubMedGoogle Scholar
  32. 32.
    Figueroa D, Figueroa F, Calvo R, Vaisman A, Espinoza G, Gili F (2014) Anterior cruciate ligament reconstruction in patients over 50 years of age. Knee 21(6):1166–1168.  https://doi.org/10.1016/j.knee.2014.08.003 CrossRefPubMedGoogle Scholar
  33. 33.
    Trojani C, Sane JC, Coste JS, Boileau P (2009) Four-strand hamstring tendon autograft for ACL reconstruction in patients aged 50 years or older. Orthop Traumatol Surg Res 95(1):22–27.  https://doi.org/10.1016/j.otsr.2008.05 CrossRefPubMedGoogle Scholar
  34. 34.
    Struewer J, Ziring E, Oberkircher L, Schüttler KF, Efe T (2013) Isolated anterior cruciate ligament reconstruction in patients aged fifty years: comparison of hamstring graft versus bone-patellar tendon-bone graft. Int Orthop 37(5):809–817.  https://doi.org/10.1007/s00264-013-1807-7 CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Wolfson TS, Epstein DM, Day MS, Joshi BB, McGee A, Strauss EJ, Jazrawi LM (2013) Outcomes of anterior cruciate ligament reconstruction in patients older than 50 years of age. Bull Hosp Jt Dis 2014 72(4):277–283Google Scholar
  36. 36.
    Cinque ME, Dornan GJ, Chahla J, Moatshe G, LaPrade RF (2017) High rates of osteoarthritis develop after anterior cruciate ligament surgery: an analysis of 4108 patients. Am J Sports Med:363546517730072.  https://doi.org/10.1177/0363546517730072
  37. 37.
    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):832–837.  https://doi.org/10.1177/0363546516678723 CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Raffaele Iorio
    • 1
  • Ferdinando Iannotti
    • 1
  • Antonio Ponzo
    • 1
  • Lorenzo Proietti
    • 1
  • Andrea Redler
    • 1
  • Fabio Conteduca
    • 1
  • Andrea Ferretti
    • 1
  1. 1.Sant’Andrea Hospital, Traumatology Sports Center “Kilk Kilgour”“La Sapienza” UniversityRomeItaly

Personalised recommendations