2023 ISAKOS Biennial Congress ePoster
Quadriceps Autograft Is A Viable Graft Choice For ACL Reconstruction In Patients Over 50 Years Old
Amit Meena, MBBS, MS, DNB, Jaipur, Rajasthan INDIA
Luca Farinelli, MD, Ancona ITALY
Christian Hoser, MD, Innsbruck AUSTRIA
Elisabeth Abermann, MD, Innsbruck AUSTRIA
Mirco Herbort, MD, Prof., Munich GERMANY
Christian Fink, MD, Prof., Innsbruck AUSTRIA
Gelenkpunkt - Sports and Joint Surgery, FIFA Medical Centre of Excellence , Innsbruck, AUSTRIA
FDA Status Not Applicable
Summary
ACL reconstruction by using QT autograft in patients older than 50 years is a safe and viable procedure to enable recovery of pre-injury level activity and to improve the quality of life.
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Abstract
Background
With increasing life expectancy and improved physiological health, sports participation has increased in older patients (age=50). These patients are increasingly involved in cutting and pivoting activities such as skiing and consequently increasing the incidence of anterior cruciate ligament (ACL) injuries. There is an increased risk of residual instability, and associated chondral and meniscal injuries in high active patients with conservative management. Therefore, ACL reconstruction is on the rise for older high demanding patients but the ideal graft choice remains controversial.
Purpose
The purpose of this study was to evaluate the patient-reported outcomes, graft failure, quadriceps rupture and sports preference after arthroscopic ACL reconstruction in patients older than 50 years who underwent arthroscopic ACL reconstruction with a quadriceps tendon (QT) autograft. The hypothesis was that arthroscopic ACL reconstruction with QT autograft in older patients will provide satisfactory results without any complications in terms of graft failure and quadriceps tendon rupture. It was also hypothesized that after arthroscopic ACL reconstruction patients will be able to return to pre-injury sports preferences and activity levels.
Methods
Between 2010 and 2020, prospectively collected data were obtained from an institutional database. Patients older than 50 years with primary arthroscopic ACL reconstruction and a minimum of 2 years of follow-up were included. Patients undergoing a revision ACL reconstruction or undergoing a primary ACL reconstruction using a graft other than a QT autograft, and patients with a contralateral knee injury or osteoarthritis (Ahlba¨ck stage 2 or higher) were excluded. A minimally invasive technique was used for QT autograft harvesting. Patients were evaluated for pre-injury and 2-year follow-up Lysholm knee score, Tegner activity level, Visual Analog Scale (VAS) for pain, graft failure, quadriceps tendon rupture, and return to sport..
Results
A total of 57 patients were included in the study. The mean age of the cohort was 54.9 ± 5.2 (range 50-75). Of the 57 reconstructions, 16 (28%) were isolated ACL reconstructions, while 41 (72%) were complex reconstructions (concomitant meniscus, cartilage and/or collateral ligament injuries). At the 2-year follow-up Lysholm knee score, Tegner activity level and VAS for pain improved to pre-injury level and no significant difference was noted between pre-injury and 2-year follow-up functional scores (p=n.s.). No significant difference was found in the functional outcomes between the isolated ACL reconstruction group and complex reconstruction groups (p=n.s.). No case of graft failure or quadriceps tendon rupture was reported. No significant difference was noted in the pre-injury and postoperative sports preference (p=n.s.) and all patients return to their desired sports activity.
Conclusion
Arthroscopic ACL reconstruction by using QT autograft in highly active older patients provides satisfactory patient-reported functional outcomes and allows recovery of the pre-injury level of activity. QT autograft is an acceptable graft option in patients older than 50 years.
Level of evidence
Level IV