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Miyamoto A, Nakamae A, Tsukisaka K, Deie M, Fujimoto E, Soda Y, Shimizu R, Adachi N. Articular Cartilage Damage in the Patellofemoral Compartment at ACL Reconstruction Predicts Poor Postoperative Subjective Outcomes in Patients Age 40 and Older. J Knee Surg 2024. [PMID: 39019471 DOI: 10.1055/a-2368-3739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
The purpose of this study was to investigate factors that influence clinical outcomes after anterior cruciate ligament (ACL) reconstruction in patients aged ≥40 years. We studied 264 patients aged ≥40 and 154 patients aged ≤20 years who underwent ACL reconstruction at several surgical centers. A logistic regression analysis was conducted to identify factors that influenced the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 1 year post-ACL reconstruction. In the older patient group, cartilage damage in the patellofemoral compartment at surgery was a significant risk factor for poor postoperative KOOS subscores (pain, activities of daily living [ADL], sports, and quality of life [QOL]). Articular cartilage damage in the lateral compartment also significantly influenced one of the postoperative KOOS subscores (symptoms). In the younger patient group, articular cartilage damage in any compartments did not influence the postoperative KOOS subscores; only two preoperative KOOS subscores (symptoms and QOL) significantly influenced their postoperative KOOS subscores. We concluded that the articular cartilage damage in the patellofemoral compartment at ACL reconstruction predicts poor KOOS subscores at the 1-year follow-up in patients aged ≥40 years. STUDY DESIGN: Cohort study (Prevalence); Level of evidence, 2.
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Affiliation(s)
- Ayato Miyamoto
- Department of Orthopaedic Surgery, Matsuyama Shimin Hospital, Matsuyama, Japan
| | - Atsuo Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Masataka Deie
- Department of Orthopaedic Surgery, Hiroshima City Hospital, Hiroshima, Japan
| | - Eisaku Fujimoto
- Department of Orthopaedic Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Yoshinori Soda
- Department of Orthopaedic Surgery, Hiroshima City Hospital, Hiroshima, Japan
| | - Ryo Shimizu
- Department of Orthopaedic Surgery, JA Onomichi General Hospital, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Meena A, Farinelli L, D'Ambrosi R, Runer A, Attri M, Rudraraju RT, Tapasvi S, Hoser C, Fink C. Both Hamstring and Quadriceps tendon autografts offer similar functional outcomes after arthroscopic ACL reconstruction in patients over 50 years of age. Arthroscopy 2024:S0749-8063(24)00494-8. [PMID: 38992514 DOI: 10.1016/j.arthro.2024.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 06/17/2024] [Accepted: 06/27/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE The purpose of this study was to compare the outcomes of hamstring tendon (HT) and quadriceps tendon (QT) autografts for anterior cruciate ligament (ACL) reconstruction in patients older than 50 years in terms of patient-reported functional outcomes, graft failure rates, complications, return to sports activity and the preference for sports. METHODS Between 2010 and 2022, prospectively collected data were obtained from an institutional database. Patients older than 50 years with primary arthroscopic ACL reconstruction using either HT or QT autograft and a minimum of 2 years of follow-up were included. Patients with concomitant meniscus, cartilage and MCL injury were also included. Patients undergoing a revision ACL reconstruction or undergoing a primary ACL reconstruction using a graft other than HT or QT autograft, and patients with a contralateral knee injury or ipsilateral osteoarthritis (Ahlback stage 2 or higher) were excluded. 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. Mann-Whitney test was used for unpaired samples, whereas the Friedman test was used for analyzing variables over time. The chi-square statistic test was used to determine differences in categorical data between groups RESULTS: The number of patients in the QT and HT groups was 85 and 143 respectively. The mean age was 54.4 [50-65] and 56.4 [50-65] for the QT and HT groups respectively, 49% and 51% were males in the QT and HT groups respectively. The two groups did not differ significantly in terms of age, gender, time from injury to surgery and concomitant injuries. No significant differences were found in the pre-injury patient-reported outcome scores (PROMs) as Lysholm, Tegner activity level and VAS for pain between the two groups (p>0.05). 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 between the two groups (p>0.05). Furthermore, at the 2-year follow-up, Lysholm score, and VAS didn't show significant differences between QT and HT groups. (p=.390; p= .131). Similarly, no differences have been reported in Tegner activity level scores between HT and QT groups at 2 years of follow-up. No significant differences in terms of minimal clinically important difference (MCID) have been detected between the two groups for Lysholm and Tegner activity scores (p = 0.410 and p = 0.420 for Lysholm score and Tegner activity level score respectively). The two groups did not differ in terms of patient's percentage of sports participation at baseline, and 2 years of follow-up (p>0.05). A significant decrease (p=0.01) in skiing/snowboarding was reported in the HT group at a 2-year follow-up compared to baseline [116 (81%) vs 98 (69%)]. No case of graft failures and quadriceps tendon rupture was reported in either of the groups. CONCLUSION Arthroscopic ACL reconstruction by using HT or QT autograft in athletically active older than 50 years patients provide satisfactory patient-reported functional outcomes and allows recovery of the pre-injury level of activity.
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Affiliation(s)
- Amit Meena
- Gelenkpunkt - Sports and Joint Surgery, FIFA Medical Center of Excellence, Innsbruck, Austria; Research Unit for Orthopedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria; Department of Orthopedics, Shalby Hospital, Jaipur, India
| | - Luca Farinelli
- Clinical Orthopedics, Department of Clinical and Molecular sciences. Università Politecnica delle Marche. Ancona, Italy
| | - Riccardo D'Ambrosi
- IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, 20161, Milan, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, Milan, Italy
| | - Armin Runer
- Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Manish Attri
- Central Institute of Orthopedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India-110029
| | | | | | - Christian Hoser
- Gelenkpunkt - Sports and Joint Surgery, FIFA Medical Center of Excellence, Innsbruck, Austria; Research Unit for Orthopedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria
| | - Christian Fink
- Gelenkpunkt - Sports and Joint Surgery, FIFA Medical Center of Excellence, Innsbruck, Austria; Research Unit for Orthopedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria.
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Roberts J, Puzzitiello R, Salzler M. Anterior Cruciate Ligament Reconstruction in Patients Over 40 Years Old Shows Low Failure Rates: A Systematic Review. Arthrosc Sports Med Rehabil 2024; 6:100899. [PMID: 38706974 PMCID: PMC11065657 DOI: 10.1016/j.asmr.2024.100899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/12/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose To review the literature reporting on complications and failure rates after primary anterior cruciate ligament reconstruction (ACLR) in patients ≥40 years. Methods This was a secondary analysis from a prior systematic review of the MEDLINE, CINAHL, SportDiscus, Embase, Web of Science, and Cochrane databases on studies evaluating clinical outcomes in ACLR patients ≥40 years. Studies were included based on the following criteria: English-language studies reporting on postoperative complications and/or ACLR failure rates in patients ≥40 years. Case reports, technical notes, studies with duplicate reporting of patient cohorts, or studies using publicly available registry data were excluded. ACLR failure definitions, failure rates, graft rupture rates, revision ACLR and non-ACLR revision rates, and complication rates were recorded. Results Twenty-one studies were included following full-text review. Autografts were used in 89.0% of cases. Definitions for ACLR failure varied, ranging from (1) revision ACLR, (2) graft rupture, (3) clinical examination of increased knee laxity, and (4) postoperative arthrofibrosis requiring an additional surgery. The median ACLR failure rate was 5.0% (range, 0%-12.1%) among the 9 studies reporting this outcome, with only 4 of the studies providing explicit definitions of failure. The median ACLR revision surgery, graft rupture, and non-ACLR revision surgery rates were 0% (range, 0%-7.7%), 2.7% (range, 0%-9.1%), and 7.2% (range 0%-34.4%), respectively. Commonly reported complications included pain (range, 0%-14.0%), stiffness (range, 0%-12.7%), hematoma (range, 2.5%-8.8%), neurovascular (range, 0%-41.7%), and undefined (range, 0%-13.8%). Conclusions ACLR in patients over 40 years old shows low failure rates. Level of Evidence Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- John Roberts
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Richard Puzzitiello
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Matthew Salzler
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
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Yoon KH, Lee SM, Park JY, Lee HS, Hwang SH. A Comparison of Results in Older, Middle-aged, and Younger Patients after Primary Anterior Cruciate Ligament Reconstruction: Minimum 10-Year Follow-up. Clin Orthop Surg 2024; 16:57-65. [PMID: 38304209 PMCID: PMC10825243 DOI: 10.4055/cios22344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/03/2022] [Accepted: 12/03/2022] [Indexed: 02/03/2024] Open
Abstract
Background Anterior cruciate ligament (ACL) reconstruction is commonly performed to prevent decreased knee function and restore stability in middle-aged and even older patients. However, few studies have compared the long-term clinical outcomes of ACL reconstruction between older, younger, and middle-aged patients. The purpose of this study was to compare the long-term clinical outcomes of ACL reconstruction in older patients with those in younger and middle-aged patients. Methods A total of 352 patients who underwent primary ACL reconstruction between January 2003 and March 2008 were retrospectively reviewed and classified into three groups (group A: 246 [age, 20-29 years], group B: 72 [age, 40-49 years], group C: 34 [age, 50-65 years]). The mean follow-up period was 14.2 ± 1.6 years. Clinical outcomes were evaluated and compared between groups. Results The differences in the range of motion, clinical scores, and stability tests were not statistically significant among the three groups. The difference in the graft failure rate among the three groups was significant (group A: 16 [6.5%], group B: 7 [9.7%], group C: 6 [17.6%]; p = 0.040). In particular, when compared between the two groups, there was a significant difference between group A and group C (p = 0.036). The 10-year survival rates were 93.5%, 90.3%, and 82.4% for groups A, B, and C, respectively (p = 0.048). Conclusions Although graft failure rates were higher in older patients than younger and middle-aged patients, clinical outcomes of ACL reconstruction in older patients were comparable to those of younger and middle-aged patients in terms of the range of motion, clinical scores, and stability tests at a minimum follow-up of 10 years.
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Affiliation(s)
- Kyoung Ho Yoon
- Department of Orthopaedic Surgery, Kyung Hee University Medical Center, Seoul, Korea
| | - Se Min Lee
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Jae Young Park
- Department of Orthopaedic Surgery, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Korea
| | - Hee Sung Lee
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Sung Hyun Hwang
- Department of Orthopaedic Surgery, Kyung Hee University Medical Center, Seoul, Korea
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Miyamoto K, Kurokouchi K, Ishizuka S, Takahashi S, Tsukahara T, Kawai R, Sakai T, Oba H, Sakaguchi T, Imagama S. Double-bundle anterior cruciate ligament reconstruction in patients aged 60 years and older. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 35:71-75. [PMID: 38235499 PMCID: PMC10793088 DOI: 10.1016/j.asmart.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 10/08/2023] [Accepted: 11/27/2023] [Indexed: 01/19/2024] Open
Abstract
Background This study aimed to examine the clinical outcomes of double-bundle (DB) anterior cruciate ligament (ACL) reconstruction in patients aged ≥60 years. Methods Anatomical DB-ACL reconstruction using hamstring tendon autografts was performed in 13 patients aged ≥60 years at our institution between June 2012 and May 2018. The patients included seven men and six women, and the mean age at surgery was 65.0 years (range, 60-73 years). The mean time from injury to surgery was 80.5 months (range, 1-480 months), and the mean follow-up time was 26.2 months (range, 24-42 months). All patients were assessed based on physical examination findings, clinical scores, Kellgren-Lawrence grades preoperatively and at the final postoperative follow-up, intraoperative meniscal or chondral lesions, and perioperative complications. Status of returning to sports for all patients was assessed at the final follow-up. Results The mean side-to-side differences by arthrometer improved from 4.3 mm (range, 2-8 mm) to 0.9 mm (range, 0-2 mm), and the positive pivot-shift test decreased from 100% to 8%. The mean extensor muscle strength was 93.3% (range, 74-116%) postoperatively. The mean Lysholm score improved from 71.1 (range, 27-85) to 95.2 (range, 89-100). Ten of the 13 patients (77%) returned to their pre-injury level of sports performance, and one patient (8%) returned to sports with less intensity. Intraoperatively, meniscal tears were observed in 10 patients (77%), and chondral lesions >grade 2 were observed in 11 (85%). One patient developed perioperative complications. At the final follow-up, the Kellgren-Lawrence grade worsened in only one patient. No re-injury or infection was observed, and revision surgery was not required for any patients. Conclusions Anatomical DB-ACL reconstruction could provide satisfactory clinical outcomes and knee function restoration in patients aged ≥60 years. Level of evidence A retrospective study, case series (IV).
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Affiliation(s)
- Kentaro Miyamoto
- Department of Orthopaedic Surgery and Arthroscopy Centre, Juko Memorial Hospital, Nagoya, Japan
| | - Kazutoshi Kurokouchi
- Department of Orthopaedic Surgery and Arthroscopy Centre, Juko Memorial Hospital, Nagoya, Japan
| | - Shinya Ishizuka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigeo Takahashi
- Department of Orthopaedic Surgery and Arthroscopy Centre, Juko Memorial Hospital, Nagoya, Japan
| | - Takashi Tsukahara
- Department of Orthopaedic Surgery, Murakami Memorial Hospital, Asahi University, Gifu, Japan
| | - Ryosuke Kawai
- Department of Orthopaedic Surgery, Murakami Memorial Hospital, Asahi University, Gifu, Japan
| | - Tadahiro Sakai
- Department of Orthopaedic Surgery, Toyota Memorial Hospital, Toyota, Japan
| | - Hiroki Oba
- Department of Orthopaedic Surgery and Arthroscopy Centre, Juko Memorial Hospital, Nagoya, Japan
| | - Takefumi Sakaguchi
- Department of Orthopaedic Surgery and Arthroscopy Centre, Juko Memorial Hospital, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Çokyaşar B, Altun O, Daşar U. Anterior Cruciate Ligament Reconstruction Improves Functional Scores and Quality of Life in Patients Older Than 50 Years of Age. Arthrosc Sports Med Rehabil 2023; 5:100806. [PMID: 37881191 PMCID: PMC10594561 DOI: 10.1016/j.asmr.2023.100806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/31/2023] [Indexed: 10/27/2023] Open
Abstract
Purpose To evaluate quality of life changes and functional outcomes of anterior cruciate ligament reconstruction in patients older than 50 years of age with anterior cruciate ligament injury. Methods Patients who were older than 50 years of age and had undergone anterior cruciate ligament reconstruction with single-bundle hamstring tendon auto graft surgery between January 2016 and February 2018 were identified. Preoperative Tegner activity scores, Lysholm knee scores, International Knee Documentation Committee (IKDC) 2000 scores, and Short-Form 36 scores were compared with results that were documented 1 year after surgery. Results A total of 35 patients were included (20 male/15 female; mean age 52 years [range 50-59 years]). Patients' preoperative mean Tegner score was 1.48. Mean Tegner score at 1-year follow-up was 3.82. Preoperative mean Lysholm score was 45.8. Postoperative mean Lysholm score was 88. Preoperative mean IKDC 2000 score was 33. Postoperative mean IKDC 2000 score was 82. All of these changes were statistically significant (P < .05). All of the parameter changes at Short Form-36 except for role limitations due to emotional problems were statistically significant. Conclusions Improved functional knee scores, quality of life, and psychological status were achieved at anterior cruciate ligament reconstruction in patients older than 50 years of age. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Batuhan Çokyaşar
- Department of Orthopedics and Traumatology, Merzifon Kara Mustafa Paşa State Hospital, Amasya, Turkey
| | - Ozan Altun
- Department of Orthopedics and Traumatology, Çankırı State Hospital, Çankırı, Turkey
| | - Uygar Daşar
- Department of Orthopedics and Traumatology, Karabuk University, Karabuk, Turkey
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Sato D, Inoue M, Kasahara Y, Hamano H, Suzuki R, Kondo E, Iwasaki N. Effects of Preserving Anatomically Positioned and Adequate Remnant ACL Tissue in Double-Bundle ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671231162389. [PMID: 37113140 PMCID: PMC10126626 DOI: 10.1177/23259671231162389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/24/2023] [Indexed: 04/29/2023] Open
Abstract
Background The advantages of remnant tissue preservation in anterior cruciate ligament (ACL) reconstruction (ACLR) remain controversial. Hypothesis It was hypothesized that a large amount of remnant tissue, especially if anatomically positioned, would improve patient-reported outcomes and second-look graft appearance after preserved double-bundle ACLR (DB-ACLR). Study Design Cohort study; Level of evidence, 3. Methods This retrospective study included 89 consecutive patients who underwent unilateral remnant-preserving DB-ACLR using 2 hamstring tendon autografts. The authors categorized the arthroscopic findings into 3 groups according to the location and volume of the ACL remnant tissue in the femoral notch: (1) anatomical attachment (group AA; n = 34); (2) nonanatomical attachment (group NA; n = 33); and (3) no remnant (group NR; n = 22). Based on second-look arthroscopy, the reconstructed graft was graded as excellent, fair, or poor. Patient-reported outcomes were evaluated at 2 years after surgery using the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Japanese Anterior Cruciate Ligament Questionnaire-25 (JACL-25). Results The AA and NA groups had a significantly shorter time from injury to surgery compared with the NR group (P = .0165). Considering the second-look arthroscopic findings, the authors found a significant difference in synovial coverage of the grafts between the 3 groups (P = .0018). There were no significant differences in the overall KOOS and JACL-25 score among the 3 groups; however, the KOOS-Sport and Recreation and KOOS-Quality of Life subscale scores were significantly higher in the AA group compared with the NA and NR groups (P = .0014 and .0039, respectively). The JACL-25 score for middle- to high-speed flexion and extension was significantly better in the AA group versus the NR group (P = .0261). Conclusion This study showed that preserving anatomically positioned and adequate remnant tissue during DB-ACLR improved second-look graft appearance and KOOS-Sport and Recreation and KOOS-Quality of Life scores.
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Affiliation(s)
- Dai Sato
- Department of Orthopaedic Surgery, NTT
East Japan Sapporo Hospital, Sapporo, Japan
| | - Masayuki Inoue
- Department of Orthopaedic Surgery, NTT
East Japan Sapporo Hospital, Sapporo, Japan
- Masayuki Inoue, MD, PhD,
Department of Orthopaedic Surgery, NTT East Japan Sapporo Hospital, Minami-1,
Nishi-15, Sapporo, Hokkaido, 060-0061, Japan (
)
| | - Yasuhiko Kasahara
- Department of Orthopaedic Surgery, NTT
East Japan Sapporo Hospital, Sapporo, Japan
| | - Hiroki Hamano
- Department of Orthopaedic Surgery, NTT
East Japan Sapporo Hospital, Sapporo, Japan
| | - Ryota Suzuki
- Department of Orthopaedic Surgery, NTT
East Japan Sapporo Hospital, Sapporo, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido
University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery,
Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo,
Japan
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Quadriceps autograft is a viable graft choice for arthroscopic ACL reconstruction in patients over 50 years of age. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07367-2. [PMID: 36917246 DOI: 10.1007/s00167-023-07367-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/24/2023] [Indexed: 03/16/2023]
Abstract
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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Roberts J, Ness B, Cleland J, Puzzitiello R, Marinch M, Wright A, Donaldson M, Salzler M. Operative Management for Anterior Cruciate Ligament Injury in Patients Over 40 Years Old Yields Increased Clinical Outcome: A Systematic Review. Arthroscopy 2023; 39:812-826.e2. [PMID: 35810978 DOI: 10.1016/j.arthro.2022.06.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate outcomes of anterior cruciate ligament (ACL) rupture in patients ≥40 years treated nonoperatively or with ACL reconstruction (ACLR). METHODS A review of MEDLINE, CINAHL, SportDiscus, Embase, Web of Science, and Cochrane databases from inception to June 1, 2021, was performed to identify randomized controlled trials, prospective or retrospective cohorts, case controls, or case series that met the following criteria: English-language studies reporting at least one subjective and/or objective outcome measure in ACL rupture patients ≥40 years treated nonoperatively or by ACLR. No limits were placed on graft type, time-to-surgery/follow-up, or concomitant procedures. Variability in patient-reported outcome scores, including subjective IKDC score, Lysholm score, Tegner activity score, and Knee Injury and Osteoarthritis Outcome Score, was assessed to evaluate the utility of applying previously established clinically meaningful thresholds to pooled outcome data. RESULTS 12,605 citations were identified using screening criteria. Sixty studies satisfied criteria following full-text review. As previous systematic reviews reported on earlier literature evaluating ACLR outcomes in patients ≥40 years, studies in this review were limited to include only those published in the last 10 years (40 studies). An additional 16 studies were excluded based on aims of the review not identified during initial screen. Although preoperative to postoperative population-based improvements in Lysholm score, Tegner score, and IKDC score surpassed minimal clinically important differences (MCID) in at least 50% of studies, the variability present in the pooled data may limit its application. No studies evaluated nonoperative outcomes. CONCLUSIONS Evidence supports operative management in patients ≥40 years, as studies generally demonstrated preoperative to postoperative improvements in clinical outcomes based on population-level changes. However, application of patient-level clinically relevant thresholds to pooled outcome data should be undertaken with caution as reporting of population-based outcome scores may not accurately reflect changes in individual patients. LEVEL OF EVIDENCE Systematic review, IV.
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Affiliation(s)
- John Roberts
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A..
| | - Brandon Ness
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Josh Cleland
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Richard Puzzitiello
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, MA, United States
| | - Mark Marinch
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Alexis Wright
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Megan Donaldson
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Matthew Salzler
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A.; Department of Orthopedic Surgery, Tufts Medical Center, Boston, MA, United States
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Ogunleye P, Jäger H, Zimmermann F, Balcarek P, Sobau C, Ellermann A, Zimmerer A. Patients older than 55 years regain sporting and recreational activities after arthroscopic anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31:632-640. [PMID: 35988115 DOI: 10.1007/s00167-022-07116-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 08/05/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE (1) To compare sporting and recreational activity levels before and at a minimum 6 year follow-up, and (2) to assess the clinical and functional outcomes after anterior cruciate ligament (ACL) reconstruction in patients older than 55 years. METHODS A retrospective evaluation of prospectively collected data of 150 patients with a mean age of 64 ± 4.5 (57-74) years was evaluated 8.6 ± 1.4 (6-11) years after primary ACL reconstruction using hamstring autograft. All patients were assessed using the International Knee Documentation Committee scoring system (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner activity level, and visual analog scale (VAS) for pain. The level of recreational activities was assessed using a sport-specific questionnaire. All patients were categorized according to Isolated and Combined ACL injury groups. RESULTS The data of 125 patients were analyzed at the last follow-up. While 25 patients were lost to follow-up, 117 of 125 patients were active before their injury in at least one sports discipline compared to 121 of 125 patients after ACL reconstruction. One hundred and two (82%) patients had returned to their recreational activities at the final follow-up. The mean IKDC subjective score increased from 49.5 ± 23.2 (11.5-100) to 76.2 ± 14.8 (33.3-100) (p < 0.0001). The mean KOOS sport increased significantly from 36 ± 36.2 (0-100) to 74.1 ± 25.5 (0-100) (p < 0.0001). The mean VAS score improved from 6.0 ± 2.6 (0-10) to 1.0 ± 1.4 (0-6) (p < 0.0001). There was no significant difference in the median Tegner activity level (preoperative 5 (2-8) vs. follow-up 5 (2-8) (n.s). There was no significant difference in the number of sports disciplines and duration when comparing pre-injury and mid-term follow-up activity after ACL reconstruction. High-impact activities experienced a significant decline, while a significant increase in participation in low-impact activities was recorded. CONCLUSION The majority of patients with symptomatic instability regained their pre-injury recreational activity level with excellent clinical and functional outcomes after arthroscopic ACL reconstruction. Nevertheless, a change from high-to low-impact activities has been observed. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Hannah Jäger
- ARCUS Kliniken, Rastatterstr 17-19, 75179, Pforzheim, Germany
| | | | - Peter Balcarek
- ARCUS Kliniken, Rastatterstr 17-19, 75179, Pforzheim, Germany
| | - Christian Sobau
- ARCUS Kliniken, Rastatterstr 17-19, 75179, Pforzheim, Germany
| | | | - Alexander Zimmerer
- ARCUS Kliniken, Rastatterstr 17-19, 75179, Pforzheim, Germany.
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine, Greifswald, Germany.
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11
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Corona K, Cerciello S, Vasso M, Toro G, D'Ambrosi R, Pola E, Ciolli G, Mercurio M, Schiavone Panni A. Age over 50 does not predict results in anterior cruciate ligament reconstruction. Orthop Rev (Pavia) 2022; 14:37310. [PMID: 35909418 DOI: 10.52965/001c.37310] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction Grown in the worldwide population of over 50 of age individuals who remain in good health and continue to engage in sports has led to an increase of anterior cruciate ligament (ACL) tears in this aged population. ACL reconstruction was reserved for young and active athletes, but seems to produce good outcomes also in over 50s. Purpose To compare the patient-reported functional scores, arthrometric outcomes, and complications of primary ACL reconstruction between older (>50 years) and younger (<50 years) patients. Methods A systematic review was performed on Pubmed, Scopus, Google Scholar and Cochrane library regarding studies that compared the clinical outcomes of ACLR between patients aged > 50 years and those aged < 50 years. The outcomes evaluated were knee functional outcomes, antero-posterior laxity and complications rate. Results This study included 5 retrospective cohort studies with a total of 645 patients (357 in the older 50 group and 288 in the younger group). All included studies reported significant improvements in clinical outcomes in both groups after ACL reconstruction. No significant differences were noted in terms of International Knee Documentation Committee (IKDC), Lysholm, Tegner scores and anteroposterior instability between the two groups (p = n.s.). Over 50 cohort seem to have an increased risk for complication rate when compared with the younger cohort (p= 0.0005). Conclusion ACL reconstruction in patients older than 50 years is a safe procedure with good results that are comparable to those of younger patients. Study design Systematic review and meta-analysis; Level of evidence, 3.
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Affiliation(s)
- Katia Corona
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy, University of Molise
| | - Simone Cerciello
- Department of Orthopaedics, A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy, Catholic University
| | - Michele Vasso
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, University "Campana Luigi Vanvitelli", Napoli, Italy, University "Campana Luigi Vanvitelli"
| | - Giuseppe Toro
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, University "Campana Luigi Vanvitelli", Napoli, Italy, University "Campana Luigi Vanvitelli"
| | - Riccardo D'Ambrosi
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy, IRCCS Istituto Ortopedico Galeazzi
| | - Enrico Pola
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, University "Campana Luigi Vanvitelli", Napoli, Italy, University "Campana Luigi Vanvitelli"
| | - Gianluca Ciolli
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Sacre Hearth Catholic University, Rome
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Alfredo Schiavone Panni
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, University "Campana Luigi Vanvitelli", Napoli, Italy, University "Campana Luigi Vanvitelli"
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12
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Weng CJ, Yang CP, Yeh WL, Hsu KY, Chang SS, Chiu CH, Chen ACY, Chan YS. Outcomes of Anterior Cruciate Ligament Reconstruction in Patients Older Than 50 Years and Younger Than 30 Years. Orthop J Sports Med 2022; 10:23259671221094788. [PMID: 35601737 PMCID: PMC9118448 DOI: 10.1177/23259671221094788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/17/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Few studies have compared the outcomes of anterior cruciate ligament (ACL) reconstruction between older patients and younger patients. Purpose: To evaluate the clinical and functional outcomes of ACL reconstruction with autologous hamstring tendon in patients >50 years and <30 years. It was hypothesized that the outcomes would be comparable between these age groups. Study Design: Cohort study; Level of evidence, 3. Methods: Patients >50 years (older group) or <30 years (younger group) who underwent ACL reconstruction surgery with autologous hamstring tendon between 2012 and 2015 at the authors’ hospital were retrospectively enrolled in this study. All patients had a minimum of 2 years of follow-up. Intraoperative findings, including cartilage and meniscal injury, were recorded, and clinical and functional outcomes were evaluated using the International Knee Documentation Committee (IKDC), Lysholm, and Tegner activity scores. We used the paired-samples t test for statistical analysis between the 2 age groups. Results: A total of 67 patients and 459 patients were included in the older and younger groups, respectively. Both groups achieved significant preoperative to postoperative improvement in IKDC (older group, from 41.4 to 88.9; younger group, from 49 to 91.2), Lysholm (older group, from 49.8 to 86.1; younger group, from 50.2 to 91.8), and Tegner (older group, from 2.7 to 4.4; younger group, from 4.6 to 6.9) (P < .05 for all) scores. The change in Tegner score from preinjury to postoperatively was not statistically significant in the older group (from 4.5 to 4.4; P = .471), although it was significant in the younger group (from 7.5 to 6.9; P < .05). No between-group differences were noted in preoperative or postoperative IKDC or Lysholm scores. Both age groups reached a high rate of return to sports activity, and no major complications or ACL retears were noted in either group. Conclusion: Comparable results after ACL reconstruction were achieved in patients >50 years compared with patients <30 years, with a high rate of return to sports activity and a low rate of complications at the 2-year follow-up. The younger group returned to a higher Tegner score, while the older group did not.
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Affiliation(s)
- Chun-Jui Weng
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan.,Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
| | - Cheng-Pang Yang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan.,Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
| | - Wen-Ling Yeh
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan.,Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
| | - Kuo-Yao Hsu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan.,Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
| | - Shih-Sheng Chang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan.,Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
| | - Chih-Hao Chiu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan.,Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
| | - Alvin Chao-Yu Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan.,Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
| | - Yi-Sheng Chan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan.,Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
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13
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Saito M, Morikawa T, Iwasaki J, Hosokawa H, Sakamoto T, Nakagawa K, Sasho T. Influence of Age on Signal Intensity of Magnetic Resonance Imaging and Clinical Outcomes in Double-Bundle Anterior Cruciate Ligament Reconstruction: Comparisons Among Different Age Groups. Am J Sports Med 2022; 50:93-102. [PMID: 34825843 DOI: 10.1177/03635465211059158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Thus far, the clinical results of anterior cruciate ligament (ACL) reconstruction have been observed to be comparable between young and older patients. In contrast, age-related changes in the structural and mechanical properties of tendons used for autografts have been described. However, age-related changes associated with graft maturation remain poorly understood. HYPOTHESES The hypotheses of this study were that (1) clinical outcomes after ACL reconstruction would be comparable between younger and relatively older patients and (2) younger patients would show lower signal intensity changes on magnetic resonance imaging scans indicative of graft maturation that would be better than that in relatively older patients. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS We retrospectively evaluated 236 patients who underwent double-bundle ACL reconstruction via the outside-in technique using hamstring autograft between January 2012 and December 2015. The patients were categorized by age into 3 groups: <20 years old, 20 to 39 years old, and ≥40 years old. Clinical outcomes were evaluated using the subjective International Knee Documentation Committee (IKDC) score, Tegner activity scale, Lysholm score, and objective assessment of joint laxity 24 months after surgery. In addition, graft maturation was evaluated using magnetic resonance imaging-derived measures of the signal intensity ratio (SIR) at 3, 6, 12, and 24 months postoperatively. Clinical outcomes and graft maturation were compared among the 3 groups. RESULTS The SIR of both bundles increased from 3 months to 12 months and decreased by 24 months, showing the same tendency in all groups. No significant difference was found in the SIR among the 3 groups at any time point (P > .05). The IKDC score was significantly lower in the ≥40-year group than in the <20-year group (P < .01). In contrast, no significant differences were noted in other clinical outcomes. CONCLUSION Patients aged ≥40 years exhibited lower IKDC scores compared with younger patients, although the results of graft maturation were comparable.
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Affiliation(s)
- Masahiko Saito
- Department of Orthopaedic Surgery, Chiba Medical Center, Chiba, Japan
| | - Tsuguo Morikawa
- Department of Orthopaedic Surgery, Chiba Medical Center, Chiba, Japan
| | - Junichi Iwasaki
- Department of Orthopaedic Surgery, Chiba Medical Center, Chiba, Japan
| | - Hiroaki Hosokawa
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takuya Sakamoto
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Chiba, Japan
| | - Takahisa Sasho
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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14
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Good functional outcomes in patient’s age > 40 years after anterior cruciate ligament reconstruction with hamstring tendon graft: a retrospective study. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00754-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Female gender and medial meniscal lesions are associated with increased pain and symptoms following anterior cruciate ligament reconstruction in patients aged over 50 years. Knee Surg Sports Traumatol Arthrosc 2021; 29:2987-3000. [PMID: 33108528 DOI: 10.1007/s00167-020-06318-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/02/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Several studies report satisfactory clinical outcomes following ACLR in older patients, but none evaluated the effects of meniscal and cartilage lesions. The aim was to evaluate the influence of meniscal and cartilage lesions on outcomes of ACLR in patients aged over 50 years. METHODS The authors prospectively collected records of 228 patients that underwent primary ACLR, including demographics, time from injury to surgery, whether injuries were work related, and sports level (competitive, recreational, or none). At a minimum follow-up of 6 months, knee injury and osteoarthritis outcome scores (KOOS), International Knee Documentation Committee (IKDC) score and Tegner activity level were recorded, and differential laxity was measured as the side-to-side difference in anterior tibial translation (ATT) using instrumented laximetry devices. Regression analyses were performed to determine associations between outcomes and meniscal and cartilage lesions as well as nine independent variables. RESULTS A total of 228 patients aged 54.8 ± 4.3 years at index ACLR were assessed at a follow-up of 14.3 ± 3.8 months. KOOS subcomponents were 85 ± 13 for symptoms, 91 ± 10 for pain, 75 ± 18 for daily activities, 76 ± 18 for sport, and 88 ± 12 for quality of life (QoL). The IKDC score was A for 84 (37%) knees, B for 96 (42%) knees, C for 29 (13%) knees, and D for 8 (4%) knees. Tegner scores showed a decrease (median 0, range -4 to 4) and differential laxity also decreased (median - 4, range - 23.5 to 6.0). KOOS symptoms worsened with higher BMI (p = 0.038), for women (p = 0.007) and for knees that had medial meniscectomy (p = 0.029). KOOS pain worsened with higher BMI (p ≤ 0.001), for women (p = 0.002) and for knees with untreated (p = 0.047) or sutured (p = 0.041) medial meniscal lesions. Differential laxity increased with follow-up (p = 0.024) and in knees with lateral cartilage lesions (p = 0.031). CONCLUSION In primary ACLR for patients aged over 50 years, female gender and medial meniscal lesions significantly compromised KOOS symptoms and pain, while lateral cartilage lesions significantly increased differential laxity. Compared to knees with an intact medial meniscus, those with sutured or untreated medial meniscal lesions had worse pain, while those in which the medial meniscus was resected had worse symptoms. These findings are clinically relevant as they could help surgeons with patient selection and adjusting expectations according to their functional demands. LEVEL OF EVIDENCE III.
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16
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Andrä K, Kayaalp E, Prill R, Irlenbusch L, Liesaus E, Trommer T, Ullmann P, Becker R. Joint effusion, anteroposterior stability, muscle strength and degree of patellofemoral osteoarthritis significantly impact outcome following revision ACL reconstruction. J Exp Orthop 2021; 8:70. [PMID: 34436684 PMCID: PMC8390615 DOI: 10.1186/s40634-021-00370-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Effusion, impaired muscle function and knee instability are considered as some of the most important factors effecting outcome following anterior cruciate ligament reconstruction (ACL-R) but the impact on revision ACL-R remains unclear. It was hypothesized that these factors will significantly worsen clinical outcome following revision ACL-R. METHODS Seventy knees (13 female and 57 male) were followed retrospectively after revision ACL-R at a mean follow-up of 47.8 ± 20.7 months. Clinical examination was based on the International Knee Documentation Evaluation Form-2000 (IKDC), Tegner activity scale. Instrumented measurement of anterior tibial translation was performed using the Rolimeter® (DJO Global, Freiburg, Germany). Bilateral circumference of the thigh was measured 10 and 20 cm proximal to the medial joint space. Cartilage was assessed according to Outerbridge classification during both primary and revision ACL-R. RESULTS Tegner activity scale decreased significantly from 7.8 ± 1.4 points at primary ACL-R to 7 ± 1.8 points at revision ACL-R, and 5.8 ± 1.7 points at the time of follow up (p < 0.001). Joint effusion (r = - 0.47, p < 0.01) and side to side differences in single leg hop test (r = - 0.48, p < 0.1) significantly correlated with inferior outcome. Cartilage lesions were found in 67% of the patients at the time of revision ACL-R compared to 38% at the time of primary ACL-R. According to the IKDC classification A was graded in three patients (4.3%), B in 35 (50%), C in 29 (41.4%) and D in three (4.3%). Joint effusion was measured in 35% of patients at the time of follow-up. Degeneration at the patellofemoral compartment of > grad 2 was responsible for IKDC grade C and D (p = 0.035). Instrumented anteroposterior site-to-site difference of ≥3 mm showed significant impact on clinical outcome (p < 0.019). CONCLUSION The study has shown that chronic effusion, quadriceps dysfunction, cartilage lesions especially at the patellofemoral compartment and side to side difference in anteroposterior stability significantly influences patient outcome after revision ACL-R. These factors require special attention when predicting patient's outcome. LEVEL OF EVIDENCE Level-IV, case-controlled study.
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Affiliation(s)
- Kathleen Andrä
- Center of Orthopaedics and Traumatology, University of Brandenburg, Medical School "Theodor Fontane", Hochstrasse 29, 14770, Brandenburg an der Havel, Germany.,Sports Clinic Erfurt, Erfurt, Germany
| | - Enes Kayaalp
- Department of Orthopedics and Traumatology, Istanbul Taksim Training and Research Hospital, Siraselviler Cad. 34433 Beyoglu, Istanbul, Turkey
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University of Brandenburg, Medical School "Theodor Fontane", Hochstrasse 29, 14770, Brandenburg an der Havel, Germany
| | | | | | | | | | - Roland Becker
- Center of Orthopaedics and Traumatology, University of Brandenburg, Medical School "Theodor Fontane", Hochstrasse 29, 14770, Brandenburg an der Havel, Germany.
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17
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Ovigue J, Bouguennec N, Graveleau N. Arthroscopic anterior cruciate ligament reconstruction is a reliable option to treat knee instability in patients over 50 years old. Knee Surg Sports Traumatol Arthrosc 2020; 28:3686-3693. [PMID: 32886155 DOI: 10.1007/s00167-020-06254-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/21/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate return to sport and clinical outcomes with at least 2 years followup after arthroscopic reconstruction ACL in population over 50 years-old. METHODS eighty-one patients aged 50 years or older underwent isolated, primary ACL reconstruction with hamstring autograft between 2014 and 2016. In all patients, a period of conservative treatment had failed (minimum 6 months), and they complained of functional instability and/or limitation during daily activity. Patients were assessed preoperatively and at the latest follow-up with a physical examination, return to sports activity, the Lysholm score, the International Knee Documentation Committee scoring system, the Knee injury and Osteoarthritis Outcome Score, and the Tegner activity scale. Data regarding complications and revision surgeries were collected at 2-year follow-up. RESULTS At the last follow-up, significant improvement in outcome scores from pre- to postoperative assessments was found. The mean overall IKDC score increased from a preoperative mean of 54.4-82.9 (p < 0.001). Mean preoperative Lysholm score increased from a preoperative mean of 67.4-90.4 (p < 0.001). The mean overall KOOS score increased from a preoperative mean (p < 0.001). Median preoperative Tegner score was 5 (range 2-8) and median postoperative score was 5 (range 1-7). 86% of patients returned to the sport, 51% to their preinjury sports level. Tegner score, before accident, was the only positive influencing factor a return to pre-injury level of the sport. CONCLUSION Arthroscopic reconstruction ACL in patients over 50 years-old resulted in excellent functional outcomes, with most patients returning to sport and at the same level they had before the injury. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jordan Ovigue
- Sports Clinic of Bordeaux-Merignac, 33700, Mérignac, France.
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18
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Yoon KH, Lee HW, Park JY, Kim SJ, Kim SG. Clinical Outcomes and the Failure Rate of Revision Anterior Cruciate Ligament Reconstruction Were Comparable Between Patients Younger Than 40 Years and Patients Older Than 40 Years: A Minimum 2-Year Follow-Up Study. Arthroscopy 2020; 36:2513-2522. [PMID: 32554076 DOI: 10.1016/j.arthro.2020.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the clinical outcomes and failure rates of revision anterior cruciate ligament reconstruction (ACLR) between young and middle-aged surgery patients. METHODS Patients who underwent revision ACLRs between January 2008 and June 2017 with a minimum 2-year follow-up were retrospectively evaluated. Patients were divided into 2 groups according to age: ≥40 years (group A) and <40 years (group B). Detailed patient demographic data, preoperative radiographic data, and concurrent meniscal and chondral lesion were reviewed. Clinical scores, laxity tests results, and graft failures were compared between groups at the final follow-up. RESULTS Eighty-six patients (group A, n = 24, 46.6 ± 4.5 years; group B, n = 62, 26.2 ± 6.3 years) were included in this study. Demographic data showed that the time interval from primary to revision ACLR was longer in group A than in group B (96.2 ± 80.9 vs. 52.0 ± 42.1 months, P = .011). Group A had a higher prevalence of chondral defects of the trochlea (P = .016). No significant differences were identified in the prevalence and severity of meniscal lesions. At the final follow-up, all clinical scores were improved postoperatively but did not differ significantly between the groups. No significant differences were identified in side-to-side difference on Telos stress radiographs (group A, 6.3 ± 5.0 mm; group B, 5.6 ± 3.8 mm; P = .403) and graft failure rate (group A, 33.3%; group B, 30.6%; P = .358) at the final follow-up. CONCLUSIONS The current study showed that the clinical outcomes of revision ACLRs in patients improved significantly in patients younger than 40 years and were comparable to those observed in patients older than 40 years at a minimum 2-year follow-up. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kyoung Ho Yoon
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Hyun Woo Lee
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Jae-Young Park
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Sang Jun Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Sang-Gyun Kim
- Department of Orthopedic Surgery, Korea University Ansan Hospital, Gyeongki-do, Korea.
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19
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Corona K, Ronga M, Morris BJ, Tamini J, Zappalà G, Cherubino M, Cerciello S. Comparable clinical and functional outcomes after anterior cruciate ligament reconstruction over and under 40 years of age. Knee Surg Sports Traumatol Arthrosc 2020; 28:1932-1945. [PMID: 31463553 DOI: 10.1007/s00167-019-05680-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 08/19/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of the present meta-analysis was to update the literature on the outcomes and complications of ACL reconstruction in patients aged 40 years and older. It has been hypothesized that patients older than 40 years of age may have comparable clinical outcomes to those of younger patients. METHODS A systematic review of articles from 1996 to 2018 was completed using Pubmed, Medline, Cochrane Reviews, and Google Scholar databases using the keyword terms "anterior cruciate ligament reconstruction" and "middle-aged OR elderly OR over 40 OR age factors." Functional and clinical outcomes (International Knee Documentation Committee, Lysholm and Tegner score and KT-1000 arthrometer), complication and graft failure rate were evaluated. RESULTS Eleven articles met inclusion criteria. In total, 306 middle-aged patients and 566 younger patients were included in this study. The mean age of patients > 40 was 49 ± 7 (range 40-75) years with a mean follow-up of 25 ± 9 months (range 12-68). The mean age of younger patients was 26 ± 2.7 (range 15-39) years with a mean post-operative follow-up of 26.7 ± 11.5 months (range 3-64). The results were slightly higher (but no significantly different) towards the younger group in terms of objective IKDC (P = n.s.), Lysholm (P = n.s.) and Tegner (P = n.s.) scores and knee laxity assessment (P = n.s.). Complication rate (P = n.s.) and graft failure (P = n.s.) were low even in this cohort. CONCLUSIONS The present meta-analysis shows that patients older than 40 years achieve comparable clinical outcomes to those of younger patients following primary ACL reconstruction. This evidence may push the surgeons toward a more aggressive approach in this specific cohort of patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Katia Corona
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Via Giovanni Paolo II, 86100, Campobasso, Italy.
| | - M Ronga
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Via Giovanni Paolo II, 86100, Campobasso, Italy
| | - B J Morris
- Sports Medicine Center, The Shoulder Center of Kentucky, Lexington, USA
| | - J Tamini
- 1a Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - G Zappalà
- ASST Papa Giovanni XXIII, Bergamo, Italy
| | - M Cherubino
- Department of Biotechnology and Lyfe Sciences (DBSV), University of Insubria, Varese, Italy
| | - S Cerciello
- Casa di Cura Villa Betania, Rome, Italy.,Marrelli Hospital, Crotone, Italy
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Tan CW, Hsu WH, Yu PA, Chen CL, Kuo LT, Chi CC, Kim D, Park G. Anterior Cruciate Ligament Reconstruction in Patients Older Than 50 Years: A Systematic Review and Meta-analysis. Orthop J Sports Med 2020; 8:2325967120915698. [PMID: 32426406 PMCID: PMC7218932 DOI: 10.1177/2325967120915698] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/03/2020] [Indexed: 12/22/2022] Open
Abstract
Background: There is no consensus regarding the best treatment approach for middle-aged patients with anterior cruciate ligament (ACL) injuries. Chronic ACL-deficient knees are often associated with instability as well as secondary meniscal and cartilage lesions. ACL reconstruction (ACLR) has achieved satisfactory outcomes in younger patients; however, the effectiveness and safety of ACLR in middle-aged patients remain uncertain. Purpose: To compare the patient-reported functional scores, arthrometric outcomes, and complications of primary ACLR between older (≥50 years) and younger (<50 years) patients. Study Design: Systematic review; Level of evidence, 3. Methods: We conducted a systematic review of cohort studies that compared the clinical outcomes of ACLR between patients aged ≥50 years and those aged <50 years. The Cochrane Central Register of Controlled Trials, Embase, and MEDLINE databases were searched for relevant studies. The Methodological Index for Non-randomized Studies (MINORS) criteria was used to assess the risk of bias and conducted a random-effects meta-analysis to combine the data, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the overall quality of the body of retrieved evidence. The primary outcome was knee functional outcomes, and secondary outcomes were arthrometric outcomes of ACLR and complications. Results: This study included 4 retrospective cohort studies with a total of 287 participants (129 in the older group and 158 in the younger group). All included studies reported significant improvements in clinical outcomes in both groups after ACLR. No significant differences were noted in the improvement of International Knee Documentation Committee (IKDC) scores (mean difference [MD], 0.20 [95% CI, −2.65 to 3.05]; P = .89) and Lysholm scores (MD, −1.98 [95% CI, −6.93 to 2.98]; P = .43) between the 2 groups. No significant differences were observed in anteroposterior stability or risk of complications between the groups. Conclusion: ACLR may be performed in middle-aged patients (≥50 years) without concern for inferior clinical and arthrometric results compared with younger patients (<50 years).
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Affiliation(s)
- Chong-Wei Tan
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Puzi, Taiwan
| | - Wei-Hsiu Hsu
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Puzi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pei-An Yu
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Puzi, Taiwan
| | - Chi-Lung Chen
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Puzi, Taiwan
| | - Liang-Tseng Kuo
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Puzi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Chi Chi
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Dokyung Kim
- School of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Geon Park
- School of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
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ACL reconstruction in over-50 year-olds: Comparative study between prospective series of over-50 year-old and under-40 year-old patients. Orthop Traumatol Surg Res 2019; 105:S259-S265. [PMID: 31648996 DOI: 10.1016/j.otsr.2019.09.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/02/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION ACL reconstruction is increasingly proposed for over-50 year-olds, although surgery had a poor reputation in this age-group, mainly due to postoperative stiffness. ACL reconstruction results were compared between two prospective series of, respectively, over-50 year-old (group 1) and under-40 year-old patients (group 2). The main study hypothesis was that ACL surgery provides the same functional results after 50 as before 40 years of age, and the secondary hypothesis was that the rate of complications does not differ. METHODS A multicenter prospective non-randomized follow-up study included 228 over-50 year-old and 130 under-40 year-old patients in 10 public and private sector centers. Epidemiological data were collected. Clinical laxity, differential laxity, KOOS, IKDC, Tegner and ACL-RSI scores and radiologic aspect were assessed pre- and post-operatively. Early (<3 months) and late (>3 months) complications were collected. Functional scores were compared between groups at last follow-up: 14.2 months (range, 3.5-30.5 months in group 1, and 20.5 months (range, 11.4-29.4 months) in group 2. RESULTS Analysis of epidemiological data showed some inter-group differences: female predominance in group 1 (59% versus 35%), longer trauma-to-surgery time in group 2 (23.6 versus 8.7 weeks), predominance of pivot-contact (team) sports in group 2 (49% versus 6%), and predominance of pivot sports (skiing) in group 1. Tegner scores were lower in group 1 (5.2 versus 7.6). Meniscal lesions were more frequent in group 1 (68% versus 36%), as were cartilage lesions (76% versus 10%). Initial laxity levels were identical (6.5mm in group 1 and 6.7mm in group 2). Type of surgery was identical: 86% hamstring graft in group 1 and 89% in group 2. There were more early complications (hematoma) in group 1; rates of late complications were comparable. Laxity at last follow-up was 2.2mm in both groups, and thus Lachman and pivot-shift test results were identical in terms of firm end-feel and absence of pivot shift. Quality-of-life assessment found higher KOOS scores in group 2, although ACL-RSI scores were identical. Global IKDC scores were slightly better in group 2, due to osteoarthritis in the older patients. CONCLUSION ACL reconstruction after 50 years of age gave good results, correcting laxity as effectively as in under-40 year-olds, with identical technique and identical rates of complications. Time to return to sports and resumed level were comparable. LEVEL AND TYPE OF STUDY III, prospective comparative non-randomized.
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Fayard JM, Wein F, Ollivier M, Paihle R, Ehlinger M, Lustig S, Panisset JC. Factors affecting outcome of ACL reconstruction in over-50-year-olds. Orthop Traumatol Surg Res 2019; 105:S247-S251. [PMID: 31564634 DOI: 10.1016/j.otsr.2019.09.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/02/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION With increasing life expectancy and ever-improving quality of life in industrialized countries, functional demand and sports levels are increasing in older subjects, who are thus exposed to central pivot lesions almost as much as younger ones. While non-operative treatment provides acceptable results, it entails significant reduction in sports level. The aim of the present study was to analyze medium-term clinical, functional and radiological results of anterior cruciate ligament (ACL) reconstruction in over-50-year-olds, in order to identify factors for failure. HYPOTHESIS The study hypothesis was that surgical management provides good results if patient selection is rigorous. PATIENTS AND METHODS A multicenter retrospective study included 398 patients undergoing ACL reconstruction between April 1, 2009 and December 6, 2016. Inclusion criteria comprised: age≥50 years, with proven ACL tear. Preoperatively, clinical work-up was supplemented by measurement of differential anterior laxity and radiologic assessment of cartilage status. Functional level was assessed on the objective IKDC score. Intraoperative data comprised type of graft and meniscal and cartilage status. The same parameters were assessed postoperatively. Functional results were assessed on objective IKDS, KOOS and ACL-RSI scores. RESULTS The mean follow-up was 42.2 months. The mean improvement in differential anterior laxity was 4.2mm. Pivot-shift showed improvement, with 97% absent or glide (p<0.001). Objective IKDC score showed significant improvement (p<0.0001). 23% of patients had poor clinical results: IKDC C or D. Preoperative explosive pivot-shift (p<0.0001), medial tibiofemoral osteoarthritis (p<0.0001) and medial meniscus lesion (p<0.002) emerged as risk factors for poor functional outcome. CONCLUSION ACL reconstruction in over-50-year-olds provided satisfactory clinical and functional results. Rigorous patient selection is mandatory, as radiologic signs of medial tibiofemoral osteoarthritis indicate a risk of poor outcome. Surgery may be proposed in patients with high functional and athletic demand, before medial meniscal lesions can set in. In case of explosive pivot shift, associated anterolateral reconstruction should be considered.
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Affiliation(s)
- Jean-Marie Fayard
- Centre orthopédique Santy, Ramsay Générale de santé, hôpital Privé Jean-Mermoz, 24, avenue Paul Santy, 69008 Lyon, France
| | - Frank Wein
- Centre chirurgical ADR, 6, rue Colette, 54000 Nancy, France
| | - Matthieu Ollivier
- Institute of movement and locomotion, orthopedic surgery, boulevard Sainte-Marguerite, 13900 Marseille, France
| | - Regis Paihle
- Orthopaedics, hôpital Sud, CHU de Grenoble, avenue Kimberley, 38130 Échirolles, France
| | - Matthieu Ehlinger
- Department of orthopaedic Surgery, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex 2, France
| | - Sébastien Lustig
- Service d'orthopédie, hôpital de la Croix Rousse, CHU de Lyon, 103, Grande Rue de la Croix Rousse, 69004 Lyon, France
| | - Jean-Claude Panisset
- Chirurgie orthopédique, clinique des cèdres, 51, rue Albert-Londres, 38230 Échirolles, France.
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- 15, rue Ampère, 92500 Rueil-Malmaison, France
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Costa GG, Grassi A, Perelli S, Agrò G, Bozzi F, Lo Presti M, Zaffagnini S. Age over 50 years is not a contraindication for anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:3679-3691. [PMID: 30944945 DOI: 10.1007/s00167-019-05450-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/25/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE To report clinical and functional results of ACL reconstruction in patients over 50 years old and investigate the influence of surgery on osteoarthritis progression in this cohort of patients. METHODS A systematic review was performed on PubMed, Scopus, Google scholar, Cochrane library and EMBASE, using a strategy search design to collect clinical studies reporting outcomes of ACL reconstruction in patients aged 50 years or older. The primary outcome measure was clinical and functional results, including failure rate defined as reoperation for revision ACL surgery or conversion to total knee arthroplasty; secondary outcomes included radiological findings, expressed according to the validated grading score. RESULTS A total of 16 studies were found suitable and included. Overall, 470 arthroscopic ACL reconstructions were performed in 468 patients (278 males, 190 females), with a mean age of 53.6 years (50-75 years). The total failure rate, described as reoperation for revision ACL surgery was 2.7% (10 knees), ranging from 0 to 14.3% in the selected studies. All papers reviewed showed a statistically significant improvement of clinical and functional scores at final follow-up, comparable to younger control group, when reported. Post-operative objective stability testing with KT-1000 arthrometer device or equivalent was performed in seven studies, with a mean side-to-side difference of 2.2 mm (0.2-2.7 mm). Radiographic signs of progression of osteoarthritis were reported in six studies, where severe signs of degeneration (grade 3 or 4 according Kellgren-Lawrence or Ahlbäck classification) shifted from 4 out of 216 knees (1.9%) before surgery to 28 out of 187 knees (15%) following ACL reconstruction, after a mean period of follow-up ranging from 32 to 64 months. CONCLUSION ACL reconstruction in patients older than 50 years is a safe procedure with good results that are comparable to those of younger patients previously reported. Age itself is not a contraindication to ACL surgery because physiological age, clinical symptoms and functional requests are more important than chronological age in decision process. Since cohort size in the present study is not large enough, and taking into account the high occurrence of concomitant meniscal and chondral lesions, more high-quality studies are necessary to draw definitive conclusions about development of osteoarthritis of the knee after ACL surgery in these patients. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Giuseppe Gianluca Costa
- II Orthopaedic Clinic and Biomechanics Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy.
| | - Alberto Grassi
- II Orthopaedic Clinic and Biomechanics Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Simone Perelli
- Università Cattolica del Sacro Cuore-Fondazione Poliambulanza, Via Bissolati n. 57, 25124, Brescia, Italy
| | - Giuseppe Agrò
- II Orthopaedic Clinic and Biomechanics Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Federico Bozzi
- Università Cattolica del Sacro Cuore-Fondazione Poliambulanza, Via Bissolati n. 57, 25124, Brescia, Italy
| | - Mirco Lo Presti
- II Orthopaedic Clinic and Biomechanics Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Stefano Zaffagnini
- II Orthopaedic Clinic and Biomechanics Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
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Kim DK, Park G, Kuo LT, Park WH. Patients older than 50 years had similar results of knee strength and anteroposterior stability after ACL reconstruction compared to younger patients. Knee Surg Sports Traumatol Arthrosc 2019; 27:230-238. [PMID: 30600340 DOI: 10.1007/s00167-018-5342-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/17/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE 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). METHODS 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. RESULTS 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]. CONCLUSIONS 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.
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Affiliation(s)
- Do Kyung Kim
- Department of Sports Medicine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - Geon Park
- Department of Sports Medicine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - Liang-Tseng Kuo
- Department of Orthopaedic Surgery and Sports Medicine Center, Chang Gung Memorial Hospital, No. 6 West Sec, Chia-Pu Road, Putz City, Chiayi, 613, Taiwan.
| | - Won Hah Park
- Department of Sports Medicine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea.
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Ollivier M. Anterior Cruciate Ligament Reconstruction: The Long Road from Science to Clinical Relevance. Knee Surg Relat Res 2018; 30:93-94. [PMID: 29843195 PMCID: PMC5990231 DOI: 10.5792/ksrr.18.939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Matthieu Ollivier
- Department of Orthopaedic Surgery, Institute for Movement and Locomotion, Sainte Marguerite Hospital, Marseille, France
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