Summary

Evaluating ACL Reconstruction with BPTB Grafts in Patients Aged 50+: Functional Results and Complication Rates at 2 Years

Abstract

Introduction

Anterior cruciate ligament (ACL) rupture alters knee kinematics, often resulting in instability and loss of functionality, which can lead to subsequent meniscal damage, recurrent instability, and articular cartilage pathology across all age groups. With the increasing life expectancy and demand for sports activities among the elderly population, there has been a rise in ACL injuries. ACL reconstruction (ACL-R) using bone-patellar tendon-bone (BPTB) autograft has been considered the gold standard; however, evidence of its use in patients over 50 years old is scarce.

Objective

The primary objective of this study is to evaluate functional outcomes, patellofemoral symptoms, and complications at 2 years in patients over 50 years old who underwent ACL-R with BPTB graft.

Methods

A retrospective evaluation was conducted on a cohort of patients over 50 years old with ACL rupture, who underwent ligament reconstruction using a BPTB autograft between January 2017 and December 2021 at a single center, with at least 2 years of follow-up. Patients with ACL injuries in the context of multiligament surgeries, and those who received synthetic augmentation with tape sutures were excluded. Demographic characteristics, surgical technique, complications, and re-interventions were recorded; functional outcomes at 2 years post-surgery were assessed using the Lysholm and KOOS QoL scales, and patellofemoral symptoms were evaluated using the Kujala score.

Results

This retrospective case series identified 33 ACL-Rs with BPTB that met the inclusion criteria. The median age was 53 years, with a predominance of males (63.6%). The average body mass index (BMI) was 28.31 (SD 3.21). Additionally, 26 patients had associated meniscal procedures (19 partial meniscectomies and 7 meniscal repairs). Regarding the surgical technique, the femoral tunnel was created via the anteromedial portal in 10 patients (30.3%) and using the outside-in technique in 23 patients (69.7%).
Two patients subsequently underwent re-intervention, one for arthroscopic fibrolysis due to stiffness and the other for a Cyclops lesion. No re-interventions were observed for meniscal pathology, and there were no infections or re-ruptures of the neo-ACL at the 2-year follow-up. Good functional outcomes were observed with a median Lysholm score of 94 (range 54-100) and a KOOS QoL score of 75 points (range 43.75-100). Additionally, minimal patellofemoral symptoms were observed, with a median Kujala score of 94 points (range 55-100).

Conclusions

In this cohort of patients over 50 years old undergoing ACL-R with BPTB autograft, good functional outcomes, minimal patellofemoral symptoms, and low complication rates were observed at the 2-year follow-up.