Anterior Cruciate Ligament Reconstruction: Effect of Age on Early to Mid-Term Clinical Outcomes.

Abstract

Objective: The aim of this study was to evaluate the influence of age on early to mid-term clinical outcomes after anterior cruciate ligament (ACL) reconstruction.

Design: Longitudinal observational study.

Setting: Anterior cruciate ligament rupture is often a debilitating condition requiring surgery to restore joint stability. Patient-reported outcome measures (PROMs) can be used to assess knee function after ACL reconstruction. Outcomes from this type of surgery are thought to be influenced by demographic factors such as age.

Patients: Subjects undergoing ACL reconstruction were allocated to either the Younger Group (<40 years) or the Older Group (≥40 years).

Interventions: Arthroscopic primary, anatomic single bundle ACL reconstruction using either middle third bone-patella tendon-bone autograft or quadrupled hamstring tendon (gracillis and semitendinosus) autograft.

Main outcome measures: Six PROMs were collected before and after ACL reconstruction that included the Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), Lysholm, Tegner, EuroQol-5 Dimension-5 Level, and Short Form 12-item Health Survey.

Results: A total of 87 patients were included in the study with a mean postoperative follow-up of 2.3 years (range 1-7 years). Preoperatively, the Younger Group had significantly better KOOS pain (P = 0.007), KOOS activities of daily living (P < 0.001), KOOS overall (P = 0.017), IKDC (P = 0.005), Lysholm (P = 0.015), Tegner (P < 0.001), and 12-item Short Form survey physical component summary (P = 0.001) than the Older Group. However, postoperatively only the Tegner (P < 0.001) was significantly better in the Younger Group, while all other scores were comparable. Overall, PROMs had very little correlation with age after surgery.

Conclusions: Older patients with ACL instability have just as much to gain as younger patients from surgical intervention. Therefore, age should not be a contraindication to ACL reconstruction.