To compare the subjective outcomes and rates of subsequent operations for patients aged 40 and older with anterior cruciate ligament (ACL) ruptures who elected nonoperative management or primary allograft ACL reconstruction (ACLR).
This was a retrospective study comparing the 2-year minimum results of nonoperative treatment and primary allograft ACLR among patients aged 40 and older presenting to a single institution between the years of 2005 and 2016. Patients who elected nonoperative management were 2:1 propensity score (PS) matched to patients who elected ACLR on the basis of age, sex, BMI, sports related mechanism of injury, Outerbridge grade III or IV chondral lesions, and medial or lateral meniscus tears. Univariate analysis was performed to compare subsequent operations, IKDC scores, Marx activity level scores, and satisfaction rates between the matched ACLR and nonoperative groups.
After 2:1 PS matching, 40 ACLR and 20 nonoperative patients were included with a mean follow-up of 5.7 years (SD 2.1 years, range 2.3 – 10.6 years). There were no significant differences between the groups in any of the matching variables. Four (10%) ACLR patients sustained a graft re-rupture treated with revision ACLR. Additionally, 7 (17.5%) ACLR and 0 nonoperative patients subsequently received further ipsilateral knee surgeries (P=0.08), including 2 total knee arthroplasties. There were no significant differences in postoperative IKDC scores (81.9±14.1 vs. 84.3±12.8, P=0.53), Marx activity level scores (5.8±4.8 vs. 5.7±5.1, P=0.96), or satisfaction rates (100% vs. 90%, P=0.11) between the ACLR and nonoperative groups.
In this PS matched analysis of patients aged 40 and older with ACL ruptures, patients who elected nonoperative management had similar subjective outcomes compared to those who elected primary allograft ACLR.