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Paper 87: Anterior Cruciate Ligament Reconstruction in Patients Age 50 and Older: Outcomes and Tips for Success

OBJECTIVES: As people remain physically active later in life, there is an increased incidence of anterior cruciate ligament (ACL) injuries in patients 50 years of age and older. Historically, ACL reconstructions have not been recommended for patients over 50 years of age. While there is abundant lit...

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Autores principales: Engler, Ian, salzler, matthew, Gill, Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9339832/
http://dx.doi.org/10.1177/2325967121S00650
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author Engler, Ian
salzler, matthew
Gill, Thomas
author_facet Engler, Ian
salzler, matthew
Gill, Thomas
author_sort Engler, Ian
collection PubMed
description OBJECTIVES: As people remain physically active later in life, there is an increased incidence of anterior cruciate ligament (ACL) injuries in patients 50 years of age and older. Historically, ACL reconstructions have not been recommended for patients over 50 years of age. While there is abundant literature on the outcomes of ACL reconstruciton in patients under 40 years of age, little has been published on the outcomes in this age group. The purpose of this study was to investigate whether ACL reconstruction in patients fifty years of age and older rwill esult in an improvement in function, stability, and quality of life at 5-year follow up. We also study the indications, outcomes, and tips for success. METHODS: A retrospective review was performed of patients fifty years or older with a minimum follow up of two years who underwent an ACL reconstruction using a bone patellar tendon bone (BPTB) allograft by a single fellowship trained orthopedic sports medicine surgeon over a sixyear period. Patients were excluded from the study if they had significant radiographic osteoarthritic changes, or concurrent ligamentous or bony procedures performed. Patients were asked to return for an evaluation, including physical examination and KT-2000 instrumented stability measurements. Both the operative and non-operative knees were evaluated for range of motion, tenderness, stability on anterior drawer, Lachman, and pivot shift testing. Bilateral KT-2000 measurements which were taken at 10, 20, and 30 pounds as well as maximum manual testing. Each measurement was taken three times and averaged. The following scores were used pre- and post-operatively to assess function and pain: Lysholm, International Knee documentation Committee (IKDC), Tegner Activity, and SF-12. A physical examine including KT-2000 measurements was performed in a subset of these patients. RESULTS: Fifty patients with an average follow-up of 5 years (range 2-8 years) underwent an ACL reconstruction using BPTB allograft. The average age at surgery was 55 years (range 50-68 years). Tegner scores improved from a pre-operative score of 3.3 to a post-operative score of 5.3 (p = .0001, 95% CI 2.2-3.5). The average post-operative IKDC score was 81.3 (SD 16.4), Lysholm score 88.5 (SD 16.3), SF-12 physical 54.3 (SD 6.6) and SF-12 mental 51.8 (SD 8.3). Forty (80%) patients reported good to excellent results, six (12%) patients reported fair results and four (8%) patients reported poor results. The patients that returned for a physical examinaiton had a range of motion that averaged flexion to 135 (SD 5.4), and all achieved full extension. There was one patient (2%) that had greater than 4mm translation on Lachman testing, and no patients had a positive pivot shift. There were no identified surgical complications. CONCLUSIONS: An anterior cruciate ligament reconstruction using BTB allograft successfully restores stability and allows return to pre-injury level of activity with few complications in patients 50 years or older at an average of 5 years follow-up. Our data set represents the largest case series of ACL reconstructions for this age demographic in the literature, using validated outcome tools, and complimented with a physical examination in a sub-set of the cohort. We have found no comparison that yields a clinically significant difference (based on MCID of 10 on theLysholm scale). Thus, older patients can be counseled to expect a functional return close to their pre-injury level, similar to younger patient cohorts.
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spelling pubmed-93398322022-08-02 Paper 87: Anterior Cruciate Ligament Reconstruction in Patients Age 50 and Older: Outcomes and Tips for Success Engler, Ian salzler, matthew Gill, Thomas Orthop J Sports Med Article OBJECTIVES: As people remain physically active later in life, there is an increased incidence of anterior cruciate ligament (ACL) injuries in patients 50 years of age and older. Historically, ACL reconstructions have not been recommended for patients over 50 years of age. While there is abundant literature on the outcomes of ACL reconstruciton in patients under 40 years of age, little has been published on the outcomes in this age group. The purpose of this study was to investigate whether ACL reconstruction in patients fifty years of age and older rwill esult in an improvement in function, stability, and quality of life at 5-year follow up. We also study the indications, outcomes, and tips for success. METHODS: A retrospective review was performed of patients fifty years or older with a minimum follow up of two years who underwent an ACL reconstruction using a bone patellar tendon bone (BPTB) allograft by a single fellowship trained orthopedic sports medicine surgeon over a sixyear period. Patients were excluded from the study if they had significant radiographic osteoarthritic changes, or concurrent ligamentous or bony procedures performed. Patients were asked to return for an evaluation, including physical examination and KT-2000 instrumented stability measurements. Both the operative and non-operative knees were evaluated for range of motion, tenderness, stability on anterior drawer, Lachman, and pivot shift testing. Bilateral KT-2000 measurements which were taken at 10, 20, and 30 pounds as well as maximum manual testing. Each measurement was taken three times and averaged. The following scores were used pre- and post-operatively to assess function and pain: Lysholm, International Knee documentation Committee (IKDC), Tegner Activity, and SF-12. A physical examine including KT-2000 measurements was performed in a subset of these patients. RESULTS: Fifty patients with an average follow-up of 5 years (range 2-8 years) underwent an ACL reconstruction using BPTB allograft. The average age at surgery was 55 years (range 50-68 years). Tegner scores improved from a pre-operative score of 3.3 to a post-operative score of 5.3 (p = .0001, 95% CI 2.2-3.5). The average post-operative IKDC score was 81.3 (SD 16.4), Lysholm score 88.5 (SD 16.3), SF-12 physical 54.3 (SD 6.6) and SF-12 mental 51.8 (SD 8.3). Forty (80%) patients reported good to excellent results, six (12%) patients reported fair results and four (8%) patients reported poor results. The patients that returned for a physical examinaiton had a range of motion that averaged flexion to 135 (SD 5.4), and all achieved full extension. There was one patient (2%) that had greater than 4mm translation on Lachman testing, and no patients had a positive pivot shift. There were no identified surgical complications. CONCLUSIONS: An anterior cruciate ligament reconstruction using BTB allograft successfully restores stability and allows return to pre-injury level of activity with few complications in patients 50 years or older at an average of 5 years follow-up. Our data set represents the largest case series of ACL reconstructions for this age demographic in the literature, using validated outcome tools, and complimented with a physical examination in a sub-set of the cohort. We have found no comparison that yields a clinically significant difference (based on MCID of 10 on theLysholm scale). Thus, older patients can be counseled to expect a functional return close to their pre-injury level, similar to younger patient cohorts. SAGE Publications 2022-07-28 /pmc/articles/PMC9339832/ http://dx.doi.org/10.1177/2325967121S00650 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc-nd/4.0/This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For article reuse guidelines, please visit SAGE’s website at http://www.sagepub.com/journals-permissions.
spellingShingle Article
Engler, Ian
salzler, matthew
Gill, Thomas
Paper 87: Anterior Cruciate Ligament Reconstruction in Patients Age 50 and Older: Outcomes and Tips for Success
title Paper 87: Anterior Cruciate Ligament Reconstruction in Patients Age 50 and Older: Outcomes and Tips for Success
title_full Paper 87: Anterior Cruciate Ligament Reconstruction in Patients Age 50 and Older: Outcomes and Tips for Success
title_fullStr Paper 87: Anterior Cruciate Ligament Reconstruction in Patients Age 50 and Older: Outcomes and Tips for Success
title_full_unstemmed Paper 87: Anterior Cruciate Ligament Reconstruction in Patients Age 50 and Older: Outcomes and Tips for Success
title_short Paper 87: Anterior Cruciate Ligament Reconstruction in Patients Age 50 and Older: Outcomes and Tips for Success
title_sort paper 87: anterior cruciate ligament reconstruction in patients age 50 and older: outcomes and tips for success
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9339832/
http://dx.doi.org/10.1177/2325967121S00650
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