Summary

ACL reconstruction in carefully selected active older patients is possible and will allow them to return to their pre-injury level of activities with very good results on functional recovery, no higher than younger patients complications, and no evolution of arthritis.

Abstract

Background

Anterior cruciate ligament (ACL) reconstruction results are traditionally excellent in younger and non-arthritic patients. During the last decades, people over 60 years old are more active than ever with more demanding physical lifestyle, and a possible ACL deficiency needs treatment so that this population returns to its prior-to-injury level of activity.

Purpose

The aims of this study are to evaluate the results of ACL reconstructions in patients over 60 years old in terms of functional recovery, return to sports and post-operative incidence of osteoarthritis, and to compare their results with published results of different age groups.

Methods

All consecutive patients over 60 years old with isolated ACL tear and no established osteoarthritic lesions (Ahlbäck grade 1 or no arthritis) were retrospectively included from 2008 to 2013. Primary ACL reconstruction was performed with the same technique in all patients using autologous hamstrings tendon graft in a single bundle way. Meniscal injuries were treated with partial debridement when required. No further treatment on cartilage lesions was performed. Post-operative rehabilitation was the same in every case. IKDC, Lysholm and KOOS scores were measured before and after surgery and the ACL-RSI (Anterior Cruciate Ligament-Return to Sport after Injury) was recorded during last follow up. Post-operative incidence of osteoarthritis was evaluated on weight-bearing x-rays, during last follow-up, and anteroposterior laxity was measured pre and post-operatively with the use of stress x-rays.

Results

Twelve patients with mean age of 61±1 years at the time of surgery were included. They were followed-up for a mean period of 49±24 months. Sixty-six per cent had associated meniscal tears and 50% of them had ICRS stage 1-2 chondral lesions. Pre-operatively objective IKDC score was grade B in 4 patients, grade C in 5 and grade D in 3. After surgery IKDC score was grade A in 4 patients, grade B in 7 and grade C in 1. Mean subjective IKDC and Lysholm scores were 43,4±8 and 55,7±12 pre-operatively and 83,8±9 and 93,2±9 at the last follow up (p<0,05). Eighty-three per cent (n=10) reported recovery of sports activities with 50% of them (n=6) reaching the same level before injury. Mean ACL-RSI was 75%. Pre-operatively, 50% (n=6) of patients had stage 1 Ahlbäch medial compartment arthritis, against 58% (n=7) at the last follow up (p=NS). Side-to-side difference of anterior tibial translation was 7,2±6.4 mm pre-operatively on stress x-rays, and 1,9±4.3 mm post-operatively (p<0,05). No major complication was reported.

Conclusion

ACL reconstruction in active patients older than 60 years old without arthritis, restored knee stability in all treated cases. Similarly to younger age groups, ACL reconstruction showed good results on functional recovery while not increasing the risk of midterm functional knee deterioration or evolution of knee arthritis. The majority of patients returned to activities at pre-injury level. These data show that older and active patients with non-arthritic ACL-deficient knees may not be ruled-out from surgical treatment.