Influence sur les lésions méniscocartilagineuses du délai accident–reconstruction du ligament croisé antérieur chez les patients de plus de 40 ans

Abstract

Anterior cruciate ligament (ACL) reconstruction is increasingly proposed for patients aged over 40 years. We report a retrospective analysis of a consecutive series of middle-aged patients who underwent ACL reconstruction surgery in order to analyze the development of meniscal and cartilage lesions and ascertain short-term outcome. Thirty-five patients aged over 40 years (mean 46.1 years) underwent hamstring ACL reconstruction, 19 for persistent instability after functional treatment and 16 after a recent tear in patients who wanted to resume their sports activities. Mean follow-up was 25 months. The IKDC 1993 score was noted as was the Arpege score for sports activity and Telos at 15 and 25kg. At the last follow-up, the IKDC score was A or B in 85% of patients. Among the first intention ligamentoplasties, 94% were scored A or B at last follow-up and all had a single leg jump test greater than 76%. Among patients operated on after failure of functional treatment, 79% were scored A or B (p>0.05) and 32% had a single leg jump test less than 75% (p<0.05). Intraoperative discovery of meniscal or cartilage damage was statistically less significant in first intention patients than after failure of functional treatment. Somewhat less than half of the active and motivated patients aged over 40 years who underwent a first intention operation were unable to resume their sports activities at the same level. However, patients who underwent ACL repair after failure of functional treatment unexpectedly recovered sports activities after an interruption of several months or even years. Age is not a barrier to ACL reconstruction. The time from injury to surgery is a prognostic factor predictive of meniscal and osteochondral damage. Early repair of the ACL preserves the knee's meniscal and cartilaginous stock. For active motivated patients aged over 40 years, who undergo a first-intention procedure, resumption of sports activities at the same level cannot be guaranteed after ACL. However, for patients who undergo surgery after failure of functional treatment, ACL reconstruction not only eliminates the troublesome laxity but also enables resumption of sports activities even after several months or years of interruption.