Is there any benefit in anterior cruciate ligament reconstruction in patients over 60 years old?
ESSKA Academy. Ntagiopoulos P. 11/08/19; 286396
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Is there any benefit in anterior cruciate ligament reconstruction in patients over 60 years old?

ESMA Free Papers

Topic: Sports Trauma

Ntagiopoulos P.1,2, Dejour D.1,3
1Mediterraneo Hospital Athens, Athens, Greece, 2Lyon Ortho Clinic, Lyon, France, 3Mediterraneo Hospital Athens, Orthopedic Dpt, Glyfada, Athens, Greece

Anterior cruciate ligament (ACL) reconstruction results are traditionally excellent in younger and non-arthritic patients. Patients over 60 yo 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.
The aims of this study are to evaluate the results of ACL reconstruction in patients over 60 yo in terms of functional recovery, return to sports and post-op incidence of osteoarthritis, and to compare their results with published results of different age groups.
All consecutive patients over 60 yo with isolated ACL tear and no established osteoarthritic lesions (Ahlbäck grade 1 or less) were included. 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. 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-op incidence of osteoarthritis was evaluated on weight-bearing x-rays, during last follow-up, and AP laxity was measured pre and post-op with the use of stress x-rays.
12 patients with mean age of 61±1 years at the time of surgery were included and followed-up for 49±24 months. 63% had associated meniscal tears and 50% of them had ICRS stage 1-2 chondral lesions. Pre-op 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-op 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-op, 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-op on stress x-rays, and 1,9±4.3 mm p.o. (p< 0,05).
ACL reconstruction in active patients older than 60 yo without arthritis, restored knee stability in all treated cases and showed good results on functional recovery while not increasing the risk of midterm evolution of knee arthritis. The majority of patients returned to activities at pre-injury level.
Is there any benefit in anterior cruciate ligament reconstruction in patients over 60 years old?

ESMA Free Papers

Topic: Sports Trauma

Ntagiopoulos P.1,2, Dejour D.1,3
1Mediterraneo Hospital Athens, Athens, Greece, 2Lyon Ortho Clinic, Lyon, France, 3Mediterraneo Hospital Athens, Orthopedic Dpt, Glyfada, Athens, Greece

Anterior cruciate ligament (ACL) reconstruction results are traditionally excellent in younger and non-arthritic patients. Patients over 60 yo 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.
The aims of this study are to evaluate the results of ACL reconstruction in patients over 60 yo in terms of functional recovery, return to sports and post-op incidence of osteoarthritis, and to compare their results with published results of different age groups.
All consecutive patients over 60 yo with isolated ACL tear and no established osteoarthritic lesions (Ahlbäck grade 1 or less) were included. 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. 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-op incidence of osteoarthritis was evaluated on weight-bearing x-rays, during last follow-up, and AP laxity was measured pre and post-op with the use of stress x-rays.
12 patients with mean age of 61±1 years at the time of surgery were included and followed-up for 49±24 months. 63% had associated meniscal tears and 50% of them had ICRS stage 1-2 chondral lesions. Pre-op 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-op 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-op, 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-op on stress x-rays, and 1,9±4.3 mm p.o. (p< 0,05).
ACL reconstruction in active patients older than 60 yo without arthritis, restored knee stability in all treated cases and showed good results on functional recovery while not increasing the risk of midterm evolution of knee arthritis. The majority of patients returned to activities at pre-injury level.
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