Abstract
Purpose of the study: The purpose of this retrospective study was to analyze outome at more than one year of 33 anterior cruciate ligament (ACL) ligmanetoplasties performed in subjects aged over 50 years.
Material and methods: Between 1997 and 2002, arthroscopic ACL ligmantoplasty with a free graft was performed for 33 patients aged 50–67 years (mean 55.2 years). All patients were reviewed clinically and radiologically at least one year after surgery (mean follow-up 31 months, range 12–60 months). IKDC criteria and manual KT-1000 measurements were recorded. All subjects were classified C or D before the operation (IKCD 93 criteria). Plain x-rays were considered normal for 21 patients (63.5%) and eight (24%) presented remodeling of the medial femorotibial compartment or the intercondylar eminences. Four knees (12.5%) presented an asymptomatic narrowing of the medial femorotibial space (< 50%). In all patients, the indication for surgery was instability for daily life and/or sports activities, even for patients presenting an asymptomatic narrowing. An inter-articular patellar tendon graft, using two independent tunnels was performed for 29 patients. A hamstring plasty was performed for the others. Mean time from injury to surgery was 18 months. There were 15 lesions of the medial meniscus (45.5%). Six lesions were not repaired because they were considered stable. The lateral meniscus was involved less often (n=11 lesions). The lateral meniscal stock was preserved in nine knees. The rehabilitation protocol was the same as used for ligamentoplasty in young sportive patients.
Results: There were no intraoperative complications. Supplementary fixation of the tibia was required for three knees. All patients resumed their sports activities at the same level. The overall IKDS score was A for eight patients, B for 19 and C for six. For the patients in class C, the poor IKDC score resulted from persistent pain, generally present before the operation. Joint motion was preserved in 30 patients. IKDC laxity was A or B in all patients. At last follow-up, there was no radiological worsening and no meniscal injury left unrepaired required secondary treatment.
Conclusion: The operative technique was joint instability for daily life activities. Stability was improved in all patients, but the surgery did not improve pain relief. Age greater than 50 years is not a contraindication for arthroscopic reconstruction of the central pivot for chronic anterior instability. Fixation of the implant must be precise. The indication for surgery depends on the severity of the instability for daily life activities in a motivated patient.
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