Allograft anterior cruciate ligament reconstruction in patients over 40 years of age

The study goal was to determine the results of allograft anterior cruciate ligament (ACL) reconstruction in patients over 40 years old at a minimum of 24 months follow-up (mean, 59.7 months; range, 24 to 110 months).

Retrospective review.

The records of 57 consecutive patients (mean age at surgery, 45.0 years; range, 40.2 to 60.8 years) were reviewed retrospectively. Nine patients who had undergone either prior ACL reconstruction, extra-articular reinforcement of the intra-articular procedure, or subsequent upper tibial osteotomy were eliminated. One patient was lost to follow-up. Of the remaining 47 patients (48 knees), 29 (62%) were men, and 18 (38%) were women. Twenty-eight of the 47 study patients (60%) were available for clinical interview consisting of physical examination, radiographs, and functional testing. Twenty-seven of these patients also underwent KT-1000 measurement, and 26 underwent Biodex evaluation. The remaining 19 patients were interviewed by telephone.

At follow-up, Lachman, anterior drawer, and pivot shift tests were 0 or 1 in 27 (96%) of 28 patients. Differences between the index and contralateral legs as measured by KT-1000 at 20 lb of force were 0 to 2 mm in 22 of 27 patients (81%) and 3 to 5.5 mm in 5 patients (19%). None had a side-to-side difference greater than 5.5 mm. Based on the International Knee Documentation Committee activity classification system, 26 (55%) of 47 patients achieved the same or higher grade of activity postoperatively as they had preinjury.

Results of ACL reconstruction in patients over 40 compare favorably with those observed in younger patients. Age should not be a limiting factor in choosing surgical reconstruction to treat functional instability in the ACL-deficient patient.