2017 ISAKOS Biennial Congress ePoster #1054

 

ACL Reconstruction in Patients Over 40 Years: A Systematic Review

Francisco Kiko Espi Escriva, MD, Valencia, Valencia SPAIN
Jose Diranzo Garcia, MD, Valencia, Valencia SPAIN
Carlos Juandó, PhD, Valencia SPAIN
Daniel Crespo, PhD, Valencia SPAIN
Pablo Renovell Ferrer, PhD, Valencia, Valencia SPAIN
Laura Castillo Ruiperez, MD, Valencia, Valencia SPAIN
Antonio Manuel Bru Pomer, MD, Valencia, Valencia SPAIN

Consorcio Hospital General de Valencia, Valencia, Valencia, SPAIN

FDA Status Cleared

Summary

Nowadays with the increase in life expectancy, older adults continue performing demanding physical activities, increasing the incidence of ACL reconstruction performed in patients 40 years or older. ACL reconstruction in these patients has excellent results, similar to the ones obtained in younger populations.

Abstract

Introduction

Anterior Cruciate Ligament Reconstruction (ACL) is one of the most common orthopedic procedures performed worldwide, with excellent recorded results in young patients.
Non-operative treatment was reserved to older patients due to low demand of the physical activities. At present, with the increase in life expectancy, older adults continue performing demanding physical activities, increasing the incidence of ACL reconstruction performed in patients 40 years or older.
Objectives: Perform a systematic review of ACL reconstruction in patients 40 years or older at the time of the reconstruction.

Methods

Systematic review of all studies on patients aged over 40 years with symptomatic ACL ruptures undergoing surgical reconstruction, published in the last 12 years (2005-2016) were considered. A literature search was performed using Pubmed/MEDLINE. The inclusion criteria included case series or case control studies. Clinical outcomes, joint stability measures, graft type, cartilage or meniscal injures and complications were recorded.

Results

A total of 1049 articles were identified in the initial search of which 15 met the inclusion criteria, with 2446 with a follow up range between 2 to 9,5 years. All studies showed an improvement of IKDC, Lisholm, Tegner Scores, and joint stability measures. The most used graft was hamstrings, followed by Bone Patellar Tendon Bone allograft. None of the studies were able to show a significant difference between the type of graft used, the functional outcome and complications. The incidence of meniscal lesions, associated as well as the chondral lesions reported in the group of patients older than 40 years seems to be higher in all papers than the incidence reported for younger patients.

Conclusion

ACL reconstruction in patients 40 years or older has excellent results, similar to the ones obtained in younger populations. Meniscal and chondral lesions were frequently found and these may have an effect in the functional outcome. Further studies with a higher level of evidence are needed to determine if age or articular status is more important factor in the decision-making strategy of the treatment of ACL tears.