Isolated anterior cruciate ligament reconstruction in patients aged fifty years: comparison of hamstring graft versus bone-patellar tendon-bone graft

Johannes Struewer, Ewgeni Ziring, Ludwig Oberkircher, Karl F Schüttler, Turgay Efe
International Orthopaedics 2013, 37 (5): 809-17

PURPOSE: Anterior cruciate ligament (ACL) deficiency contributes to symptomatic functional instability of the knee, regardless of age. We evaluated patient-reported clinical outcome, instrumental stability and prevalence of radiological osteoarthritis based on two homogenous patient samples aged 50 years, an average of three years after isolated ACL reconstruction.

METHODS: ACL reconstruction using a bone-patellar tendon-bone (BPTB) autograft was done in 19 patients and a four-stranded semitendinosus tendon (ST) autograft in 22 patients. Clinical and functional follow-up assessment was performed an average of 32 months after surgical treatment. Clinical and functional follow-up assessment included the International Knee Documentation Committee (IKDC) score, Tegner score and Lysholm score. Instrumental stability testing was carried out using the KT-1000™ arthrometer. The degree of degenerative changes and prevalence of osteoarthritis was based on the Kellgren-Lawrence classification.

RESULTS: Mean follow-up was 32 months (range, 28-36). Mean age was 49.4 years in both groups. The median pre-injury Tegner score was 5.5 (range, 2-8) and the median preoperative Lysholm score was 35 (range, 15-69). At two years, all variables improved significantly for both groups compared to the preoperative values (P < 0.05), with no significant intergroup differences. Approximately 76 % of patients were graded A or B according to the IKDC score in both groups. Activity level according to the scores of Tegner and Lysholm was 4.9/5.3 and 83.4/82.5 on two-year-follow up in both groups. Radiological assessment reported degenerative changes of grade I Osteoarthritis (OA) in 36 % of patients. Grade-II OA was found in 31 % of patients. Grade-III OA and grade-IV OA were found in about 24 % and 7 % of all patients, respectively. Correlation analyses showed significant relationships between conservation of knee-joint stability and clinical outcome according to the IKDC score, and activity level according to the Lysholm score (p < 0.05).

CONCLUSION: Arthroscopic ACL reconstruction using either BPTB graft or hamstring graft in appropriately selected middle-aged patients results in patient satisfaction and good clinical results, with return to a reasonable level of activity regardless of surgical method and graft choice.

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