Anterior cruciate ligament reconstruction in the elderly: 5-Year follow-up study

Older adults remain active for longer and continue sports and activities that require rotation on one leg later in life. The rate of anterior cruciate ligament (ACL) tears is therefore increasing in those over 40 years old, with an associated increase in the rate of surgical reconstruction (ACLR), but there is limited literature on its effectiveness. Our aim was to compare the outcomes of elderly patients who have undergone ACLR with those of a younger group of patients.

Patients who underwent ACLR with bone-patella tendon-bone grafting (BPTB) at a level I trauma center between 2015 and 2017 were included in the study with a 5-year follow-up. Patients were divided into 4 groups: below 40 years, 40-49 years, 50-59 years and over 60 years. The graft function was evaluated by the International Knee Documentation Committee (IKDC) Objective Score, the anteroposterior (AP) displacement was measured by arthrometer (KT-1000; MEDMetric) and the Lysholm scale was used for subjective evaluation.

195 patients were included in the final analysis. The IKDC score showed significantly poorer scores in the 50-59 years and over 60 years group than in the younger groups, however in 83 % and 66 % of cases reached normal or nearly normal grades, respectively. A significant difference was found in the knee AP displacement (measured in mm) between the below 40 years group and 50-59 years as well as over 60 years old groups; however, the number of graft failure (laxity >5 mm) and elongation (>3 mm) did not increased in these senior groups. The patient-reported Lysholm scores in the 40-49 years, 50-59 years and 60 years groups was lower than in the below 40 years group, but the average score was "good".

The long-term results of ACL reconstruction in older athletes are comparable to those of younger patients, both in terms of knee function and patient satisfaction. Furthermore, there is no difference in outcomes for older patients over the age of 40 compared to those in their 50 s or even 60 s. There is still insufficient published evidence to define an upper age limit for ACL reconstruction in older athletes.