Outcomes and Complication Rates After Primary Anterior Cruciate Ligament Reconstruction Are Similar in Younger and Older Patients
Authors: Cinque Mark E. , Chahla Jorge , Moatshe Gilbert , DePhillipo Nicholas N. , Kennedy Nicholas I. , Godin Jonathan A. , LaPrade Robert F. 
Published: October 2017

Background:

Until recently, anterior cruciate ligament (ACL) tears in older patients were treated conservatively; however, these patients often experienced significant pain and instability.

Purpose/Hypothesis:

The purpose of this study was to compare the patient-reported outcomes, patient satisfaction, and failure rates of primary ACL reconstruction between a younger (age 20-30 years) and older (age 50-75 years) patient cohort. It was hypothesized that patients in the older cohort could achieve comparable clinical outcomes and retear rates following ACL reconstruction with a bone-tendon-bone autograft or allograft compared with the younger patients.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A retrospective analysis of prospectively collected data was performed. All patients undergoing a primary ACL reconstruction between 2010 and 2014 by a single surgeon were collated. Patients were divided into 2 groups based on age at the time of surgery: a younger cohort (20-30 years) and an older cohort (50-75 years). Patients were excluded if they were outside the desired age intervals; had revision ACL reconstructions; had a previous intra-articular infection in the ipsilateral knee; underwent prior alignment correction procedure, cartilage repair, or transplant procedure; had a concurrent posterior cruciate ligament tear; received meniscal allograft transplant; or had an intra-articular fracture. Subjective outcome scores (Tegner activity scale, Lysholm, International Knee Documentation Committee [IKDC], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], Short Form–12 [SF-12] mental health component summary [MCS], and SF-12 physical component summary [PCS]), retear rate, and rate of secondary arthrofibrosis surgery were documented at a minimum 2-year follow-up and were compared between groups.

Results:

A total of 85 patients met the inclusion criteria for this study: 52 patients (33 males, 19 females) in the younger cohort and 33 patients (14 males, 19 females) in the older cohort. No significant differences were found in any demographic factor except for age. Significant improvement in outcome scores from pre- to postoperative assessments was found in both groups. The younger cohort had significantly lower postoperative WOMAC scores ( P = .025). However, no significant differences were found between the younger and older cohorts in postoperative SF-12 PCS ( P = .487), SF-12 MCS ( P = .900), Lysholm score ( P = .660), IKDC score ( P = .256), Tegner activity score ( P = .420), or patient satisfaction ( P = .060). Within the older cohort, increasing age did not correlate with inferior postoperative outcome scores. Furthermore, no retears occurred in either group, and the rates of arthrofibrosis surgery were comparable (12% older cohort vs 13% younger cohort).

Conclusion:

Improved function and satisfaction, comparable to the younger age group, were achieved in patients older than 50 years undergoing ACL reconstruction. Furthermore, low failure rates can be achieved in both younger and older patients undergoing ACL reconstruction.