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ACL reconstruction does not prevent the onset of OA in older patients, study finds

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BALTIMORE — Though reconstruction is an effective procedure for patients 40 years and older with ACL injuries, it does not prevent osteoarthritis development and patients should be cautioned as such, researchers recently found.

Michell Ruiz-Suarez, MD, MS, presented the findings here at the American Orthopaedic Society for Sports Medicine Annual Meeting 2012.

“We know ACL reconstruction is the standard treatment in cases of insufficiency, and the stability and satisfaction have been reported to be similar in older populations when compared to the younger ones,” Ruiz-Suarez, of Mexico City, said. “Nevertheless, ACL reconstruction has not proven to prevent osteoarthritis (OA).”

The researchers looked at 22 men and 7 women who underwent ACL reconstruction with a single surgeon from 1994 to 2005 and were aged 40 years or older at the time of surgery. They were evaluated with the Lysholm, Cincinnati and Tegner scores and an OA evaluation was performed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Kellgren-Lawrence classification.

Mean time from injury to surgery was 34.2 months with 125.1 months follow-up, mean, Ruiz-Suarez reported. Pre- and postoperative Lysholm and Cincinnati scores improved significantly, he noted, with final KOOS results being 86.7 points for pain, 85.2 points for symptoms, 90.5 pints for activities of daily living, 81.1 points for sports/recreation and 82.5 points for quality of life.

Median Tegner scores went from 7 to 4.

Ruiz-Suarez said all patients' OA appearance increased compared to their preoperative stage and their non-injured knee, but none progressed more than one stage. Meniscal and chondral statuses were not found to influence final results, and 90% of patients reported they were satisfied or very satisfied with the results.

“Age should not be a limiting factor for ACL reconstruction, but we have to tell the patients it does not prevent OA development,” Ruiz-Suarez said. “This procedure does not prevent OA evolution, therefore patients with grade 3 staging at the time of surgery may not be adequate candidates. [OA] seems to develop more rapidly from a radiographic point of view, but it does not correlate with clinical findings.”

Reference:

Miguel A, Ruiz-Suarez M, Rodriguez-Gutierrez MC, et al. Knee function and osteoarthritis in patients with anterior cruciate ligament reconstruction older than forty years-old at the time of surgery: A five to fifteen year follow-up. Paper #38. Presented at the American Orthopaedic Society for Sports Medicine Annual Meeting 2012. July 12-15. Baltimore.

Disclosure: Ruiz-Suarez has no relevant financial disclosures.