ACL Reconstruction in Patients Over 40 Years of Age: A Case Control Study (SS-60)

Abstract

Introduction More than 75,000 anterior cruciate ligament (ACL) reconstructions are performed annually in the United States. The majority of patients electing to undergo ACL reconstruction are younger, active individuals who demonstrate rotational instability of the knee; however, there are a significant number of patients who are maintaining active lifestyles into the fifth decade of life, necessitating treatment within this cohort as well. The purpose of the present investigation was to determine the outcomes of isolated ACL reconstruction in active patients over the age of 40, and to compare these results with those of a younger patient cohort undergoing the same procedure. Methods A retrospective review of all patients over 40 years of age who underwent ACL reconstruction at our institution between 2000-2008 was performed. A consecutive series of patients under the age of 25 years during this same period was selected as a control group and served as comparison. Age, gender, graft type, concomitant injuries, complications, and a validated outcome measure (Lysholm) were assessed at final follow-up. Statistical analyses were performed using the Fisher exact t-test (p<0.05). Results 45 patients in the >40 year group (average age 44.9) were identified (28 male, 17 female) and compared to 48 patients (average age 21) in the <25 year age group (23 males, 25 female) with an average follow-up of 5.7 years and 3.1 years, respectively. Associated injuries in the >40 group included lateral meniscus tears (22 patients), medial meniscus tears (22 patients), collateral ligament sprains (17 patients), articular cartilage degeneration (35 patients), and bone bruises (15 patients). Associated injuries in the younger cohort were not significantly different with the exception of the degree of cartilage degeneration (p = .0001) and lateral collateral ligament sprains (p = .026). Lysholm scores averaged 89.5 in the older cohort compared to 89.2 in the younger, with no statistical difference between groups. Conclusion Patients undergoing ACL reconstruction in the fifth decade of life demonstrated outcomes comparable to younger patients undergoing the same procedure. Chondral injuries, although present to a greater degree in the older cohort, were not associated with a poorer outcome at intermediate follow-up. More than 75,000 anterior cruciate ligament (ACL) reconstructions are performed annually in the United States. The majority of patients electing to undergo ACL reconstruction are younger, active individuals who demonstrate rotational instability of the knee; however, there are a significant number of patients who are maintaining active lifestyles into the fifth decade of life, necessitating treatment within this cohort as well. The purpose of the present investigation was to determine the outcomes of isolated ACL reconstruction in active patients over the age of 40, and to compare these results with those of a younger patient cohort undergoing the same procedure. A retrospective review of all patients over 40 years of age who underwent ACL reconstruction at our institution between 2000-2008 was performed. A consecutive series of patients under the age of 25 years during this same period was selected as a control group and served as comparison. Age, gender, graft type, concomitant injuries, complications, and a validated outcome measure (Lysholm) were assessed at final follow-up. Statistical analyses were performed using the Fisher exact t-test (p<0.05). 45 patients in the >40 year group (average age 44.9) were identified (28 male, 17 female) and compared to 48 patients (average age 21) in the <25 year age group (23 males, 25 female) with an average follow-up of 5.7 years and 3.1 years, respectively. Associated injuries in the >40 group included lateral meniscus tears (22 patients), medial meniscus tears (22 patients), collateral ligament sprains (17 patients), articular cartilage degeneration (35 patients), and bone bruises (15 patients). Associated injuries in the younger cohort were not significantly different with the exception of the degree of cartilage degeneration (p = .0001) and lateral collateral ligament sprains (p = .026). Lysholm scores averaged 89.5 in the older cohort compared to 89.2 in the younger, with no statistical difference between groups. Patients undergoing ACL reconstruction in the fifth decade of life demonstrated outcomes comparable to younger patients undergoing the same procedure. Chondral injuries, although present to a greater degree in the older cohort, were not associated with a poorer outcome at intermediate follow-up.