Good long-term functional results seen in middle age patients after ACL surgery

Postoperative Tegner scores in older athletes were comparable to the general population.

LAS VEGAS — Patients who underwent primary ACL reconstructions when they were at least 40 years old fared well at their 17- to 20-year follow-up, according to their surgeon.

The patients, whose ACLs were reconstructed with bone-patellar tendon-bone autografts, had long-term clinical scores similar to those they turned in at an average 4.6 years postop, J. Richard Steadman, MD, said.

“At 20 years after ACL reconstruction, at an average age of 63, patients had similar function and activity level to other individuals,” he said at the American Academy of Orthopaedic Surgeons 76th Annual Meeting, here.

Questionnaire used

Among the original 72 patients Steadman operated on (42 men, 30 women), there was a 96% follow-up rate when mid-term results were compiled and published in 1998.

J. Richard Steadman

By the time Karen K. Briggs, MPH, compiled the current investigation’s data, six patients required total knee replacement (TKR) at an average of 17 years after the reconstruction, Steadman said.

“We expected these patients would have decreased activity and function at 16 to 22 years following their ACL reconstruction, particularly because they were older at the time of surgery,” Steadman explained.

All patients were sent a questionnaire to determine their Lysholm and Tegner activity scores and current satisfaction with their ACL surgeries; 19.4% did not or could not respond.

Continued function

By the 20-year average follow-up, 11 patients had undergone at least one other arthroscopy surgery.

Lysholm scores averaged 88 points (range, 65-100), median Tegner scores were 5 and satisfaction was 9 (10 = very satisfied). By comparison, the normal population’s average Tegner scores were 5.1.

“These patients were quite happy with their results 20 years after their reconstruction,” Steadman said, noting eight cases, performed at a time when many major centers still did not offer this surgery, were performed via open arthrotomy.

Patients’ Lysholm scores were 63 preoperative and 94 at the previous follow-up. Steadman said differences between mid- and long-term Lysholm scores were not statistically significant, which showed a good, lasting functional result.

Study weaknesses

Steadman cited the lack of a control group and objective data for knee pain and arthritis among the study’s weaknesses. Also, it included a narrow population who agreed to strict rehabilitation and were highly motivated.

“This study shows that if you can avoid a knee replacement, you can expect to have good results 20 years after an ACL reconstruction,” he said.

Responding to question from the audience during the paper’s discussion, Steadman explained the delay between injury and surgery in the series was about 2 weeks or when the patient’s knee pain, motion, strength and heat in the joint met his clinical indications for reconstruction.

Joseph A. Bosco III, MD, who co-moderated the session, questioned Steadman’s implication that ACL reconstruction staves off osteoarthritis in light of a 12% TKR rate. Steadman agreed the number was high vs. the general population, but highlighted the merits of regaining mobility and range of motion.

For more information:

• Joseph A. Bosco III, MD, can be reached at 530 1st Ave., Suite 8U, New York, NY 10016; 212-2192; e-mail: joseph.bosco@nyumc.org. He receives research/institutional support from Johnson & Johnson.
• J. Richard Steadman, MD, can be reached at Steadman Hawkins Research Foundation, 181 West Meadow Drive, Suite 410, Vail, CO 81657; 970-476-1100; e-mail: watts@steadman-hawkins.com. He receives research/institutional support from Arthrex, Ossur, Smith & Nephew and Genzyme and has stock/stock options with Regeneration Technologies Inc. and Regen Biologics.

References:

• Briggs KK. Steadman JR, Tello T. ACL reconstruction in patients 40 years of age and older: 20 year follow-up. #11. Presented at the American Academy of Orthopaedic Surgeons 76th Annual Meeting. Feb. 25-28 2009. Las Vegas.
• Plancher KD, Steadman JR, Briggs KK, Hutton KS. Reconstruction of the anterior cruciate ligament in patients who are at least forty years old. A long-term follow-up and outcome study. J Bone Joint Surg (Am). 1998;80(2):184-197.