Anterior Cruciate Ligament Reconstruction in the Over Forty Age Group

D P Johnson

The aim of this study was to analyse the use of a bone-patella tendon-bone autograft for the reconstruction of the anterior cruciate ligaments in patients with persistent instability and restricted function over the age of 40 years. A prospective review of utilising an arthroscopic assisted technique, utilising a 10mm autograft secured with Interference Fit Screws. A consecutive group of 14 patients over the age of 40 years at the time of surgery was compared with a concurrent series of 50 patients under the age of 40. Regular post-operative clinical and radiological review was undertaken. Objective laxity testing was undertaken by one observer using a standard protocol.

The mean age of this population was 44 years (range 40 to 51 years). Follow up was obtained in all patients for a mean 19 months. This group of patients was compared with a group of 43 consecutive patients mean age 29 years. The results demonstrated that all patients over the age of 40 obtained subjective and objective stability of their knee. When asked 98% under the age and 100% of patients over the age of 40 considered their knee to be good or excellent. One patient under the age of 40 had clinical giving way and a failed graft. Clinical laxity measurement using the KT1000 Dynamometer demonstrated a normal laxity of less than 3mm in 91% of patients under the age of 40 and 100% of patients over the age of 40. 2% of patients under the age of 40 had a measurement of greater than 5 mm, confirming a ruptured graft. Clinical analysis demonstrated all patients in the group over 40 to have a negative pivot shift compared with 7% of patients under the age of 40 having an abnormal pivot shift examination. Analysis of the pre and post operative Lysholm score demonstrated an improvement in both groups. International Knee Documentation Committee Scoring analysis demonstrated a normal or nearly normal score in 93% of patients under the age of 40 compared with 100% of patients over the age of 40.

In conclusion we would suggest that these patients were able to undertake a normal rehabilitation and obtain a full range of motion. Utilising this graft resulted in excellent subjective and objective stability. Anterior knee pain was only present in 7% of patients and not associated with any restriction in function. Although none of the patients in this group required reconstruction for posterio-lateral rotary instability or for excessive varus, these factors must be considered prior to undertaking reconstruction in this population.

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