Summary

Comparative Outcomes of BPTB and HT Grafts in ACL Reconstruction for Patients Aged 50 and Above

Abstract

Introduction

Anterior cruciate ligament (ACL) ruptures are the most common ligament injury, with an annual incidence of 68.6 per 100,000 person-years. The increase in life expectancy and demand for sports activities in the older population has led to a rise in ACL injuries. Outcomes after ACL reconstruction (ACLR) are well-studied and documented, although most ACLR studies predominantly focus on patients under 50 years of age.

Objective

The primary purpose of this study is to evaluate and compare the functional outcomes in patients over 50 years old who underwent ACLR using either a bone-patellar tendon-bone (BPTB) or hamstring (HT) autograft. Secondary objectives are to assess complications related to surgery and the need for reintervention between both groups.

Methods

A cohort of patients over 50 years old with ACL rupture, who underwent ligament reconstruction with BPTB and HT autografts between January 2017 and December 2021, with at least 2 years of follow-up, was independently reviewed at a single center. Patients with ACL injuries in the context of multi-ligament surgeries, those who received synthetic augmentation with tape sutures, associated anterolateral procedures, and those who chose another type of autograft or allograft were excluded. Patient demographics, surgical technique, complications, and reinterventions were recorded. The primary outcome was the difference in functional outcomes at 2 years post-surgery using the Lysholm and KOOS QoL scales, while secondary outcomes included complications based on reinterventions related to the primary surgery. The Chi-square test was used to determine statistical differences between categorical variables, and the Mann-Whitney test was used for continuous variables, with

Significance

level of p < 0.05.

Results

This retrospective study of non-concurrent cohorts identified 69 ACLRs that met the inclusion criteria: 33 BPTB and 36 HT. The median age was 53 years (range 50–63) in the BPTB group and 53.5 years (range 50–62) in the HT group (p = 0.557), with 63.6% of men in the BPTB group and 58.3% in the HT group (p = 0.652). Both groups were comparable in the rest of their demographic characteristics and comorbidities. The median Lysholm and KOOS QoL scores were 94 and 75 points in the BPTB group and 90 and 65.62 in the HT group, with no statistically significant differences between the groups, p = 0.363 and p = 0.445, respectively. Regarding complications at 2 years of follow-up, there was 1 case of graft re-rupture in the HT group versus none in the BPTB group, 3 cases of stiffness requiring arthrolysis in the HT group versus 1 in the BPTB group, and 1 episode of cyclops lesion in each group. None of the complications showed a statistically significant difference (p = 0.338, p = 0.346, and p = 0.950, respectively). No infections were observed in either group.

Conclusions

Both the BPTB and HT reconstruction techniques demonstrated good functional outcomes and low complication rates in this cohort of patients over 50 years old with surgically managed ACL rupture. Future prospective, randomized studies are required to confirm these findings.