This article is more than 5 years old. Information may no longer be current.
ACL surgery techniques yield similar knee stability results in middle-aged patients
Double-bundle reconstruction proved as successful as single-bundle in 14 patients aged 50 years and older.
Click Here to Manage Email Alerts
Italian surgeons found no statistically significant differences in outcomes when they performed either arthroscopic single-bundle or double-bundle primary ACL reconstruction technique in patients aged 50 years or older, according to results of this study.
“Operative treatment showed favorable outcomes in most of the ACL-reconstructed patients with regard to knee stability, osteoarthritis progression and patient satisfaction in a cohort of subjects aged 50 years or older,” Alberto Ventura, MD, and colleagues wrote in the abstract of their study.
“Our subgroup of patients undergoing double-bundle (DB) ACL reconstruction reported average satisfactory outcomes which did not significantly differ from the single-bundle group,” they noted.
Ventura told Orthopaedics Today Europe the investigators used only autograft hamstring grafts and an arthroscopic technique in the procedures they performed and studied.
Patient motivation affects outcomes
“According to our findings, ACL reconstruction can be successful in appropriately selected, motivated patients aged 50 years of older,” Ventura said. “In order to maximize the outcome, selection criteria must be strict and the injured knee must not have more than minimal arthritic changes,” he said.
Based on results of the retrospective study, which was published in Arthroscopy and, according to the authors, this is one of the first investigations to present outcomes with DB ACL reconstruction in middle-aged patients specifically. Most patients in both groups saw a postoperative increase in knee function and symptoms and clinical and instrument laxity testing.
The findings also showed that the Lysholm, Tegner and International Knee Documentation Committee scores were also improved at follow-up in both groups.
New DB surgery findings
Patients in this study were a mean age of 54 years old at the time of surgery and had waited 32.6 months, mean, from injury until treatment. In all, 36 patients underwent single-bundle ACL reconstruction and 14 patients underwent a DB reconstruction procedure.
Patient osteoarthritis levels did not increase at follow-up, which, according to the abstract, occurred at 4.4 years mean and ranged from 2 years to 7 years postoperatively.
Concerning results of the special subgroup of patients that underwent DB ACL reconstruction procedure, Ventura said, “DB ACL reconstruction is suitable for patients aged over 50 who desire to return to cutting and pivoting sports, since theoretically it brings potential advantages of improved rotation stability. However, we could not detect any significant differences in terms of clinical outcome and osteoarthritis progression compared to patients who underwent traditional single-bundle reconstruction.”
Today, a patient’s physiological age and activity level are more important than their chronological age when considering which ACL primary reconstruction procedure is indicated for them, Ventura noted. – by Susan M. Rapp
Reference:
Ventura A. Arthroscopy. 2012. doi:10.1016/j.arthro.2012.04.146.
For more information:
Alberto Ventura, MD, can be reached at Minimally Invasive Articular Surgery Unit, Istituto Ortopedico G. Pini, in Milan, Italy; email: alberto.ventura@doctoral.it.
Disclosure: Ventura has no relevant financial disclosures.