II Orthopaedic Clinic and Biomechanics Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy.
Università Cattolica del Sacro Cuore-Fondazione Poliambulanza, Via Bissolati n. 57, 25124, Brescia, Italy.
Knee Surg Sports Traumatol Arthrosc. 2019 Nov;27(11):3679-3691. doi: 10.1007/s00167-019-05450-1. Epub 2019 Apr 3.
To report clinical and functional results of ACL reconstruction in patients over 50 years old and investigate the influence of surgery on osteoarthritis progression in this cohort of patients.
A systematic review was performed on PubMed, Scopus, Google scholar, Cochrane library and EMBASE, using a strategy search design to collect clinical studies reporting outcomes of ACL reconstruction in patients aged 50 years or older. The primary outcome measure was clinical and functional results, including failure rate defined as reoperation for revision ACL surgery or conversion to total knee arthroplasty; secondary outcomes included radiological findings, expressed according to the validated grading score.
A total of 16 studies were found suitable and included. Overall, 470 arthroscopic ACL reconstructions were performed in 468 patients (278 males, 190 females), with a mean age of 53.6 years (50-75 years). The total failure rate, described as reoperation for revision ACL surgery was 2.7% (10 knees), ranging from 0 to 14.3% in the selected studies. All papers reviewed showed a statistically significant improvement of clinical and functional scores at final follow-up, comparable to younger control group, when reported. Post-operative objective stability testing with KT-1000 arthrometer device or equivalent was performed in seven studies, with a mean side-to-side difference of 2.2 mm (0.2-2.7 mm). Radiographic signs of progression of osteoarthritis were reported in six studies, where severe signs of degeneration (grade 3 or 4 according Kellgren-Lawrence or Ahlbäck classification) shifted from 4 out of 216 knees (1.9%) before surgery to 28 out of 187 knees (15%) following ACL reconstruction, after a mean period of follow-up ranging from 32 to 64 months.
ACL reconstruction in patients older than 50 years is a safe procedure with good results that are comparable to those of younger patients previously reported. Age itself is not a contraindication to ACL surgery because physiological age, clinical symptoms and functional requests are more important than chronological age in decision process. Since cohort size in the present study is not large enough, and taking into account the high occurrence of concomitant meniscal and chondral lesions, more high-quality studies are necessary to draw definitive conclusions about development of osteoarthritis of the knee after ACL surgery in these patients.
IV.
报告 50 岁以上患者前交叉韧带（ACL）重建的临床和功能结果，并研究手术对该年龄组患者骨关节炎进展的影响。
通过系统综述，在 PubMed、Scopus、Google Scholar、Cochrane 图书馆和 EMBASE 上使用策略搜索设计来收集报告 50 岁或以上患者 ACL 重建结果的临床研究。主要结局指标为临床和功能结果，包括定义为 ACL 翻修手术或转为全膝关节置换术的再手术的失败率；次要结局包括放射学发现，根据经过验证的分级评分进行表达。
共发现 16 项符合条件的研究并纳入。总体而言，468 例患者（278 例男性，190 例女性）共进行了 470 例关节镜 ACL 重建，平均年龄为 53.6 岁（50-75 岁）。选定研究中，总失败率（定义为 ACL 翻修手术的再手术）为 2.7%（10 例膝关节），范围为 0-14.3%。所有审查的论文在最终随访时均显示出临床和功能评分的统计学显著改善，与报道的年轻对照组相当。在七项研究中使用 KT-1000 关节测量仪或同等设备进行术后客观稳定性测试，平均侧间差异为 2.2 毫米（0.2-2.7 毫米）。在六项研究中报告了骨关节炎进展的放射学征象，根据 Kellgren-Lawrence 或 Ahlbäck 分类，在手术前，严重退变（3 或 4 级）的征象从 216 例膝关节中的 4 例（1.9%）转变为 187 例膝关节中的 28 例（15%），随访时间平均为 32-64 个月。
50 岁以上患者的 ACL 重建是一种安全的手术，结果良好，与先前报道的年轻患者相当。年龄本身并不是 ACL 手术的禁忌症，因为生理年龄、临床症状和功能要求在决策过程中比实际年龄更重要。由于本研究的队列规模不大，并且考虑到同时存在半月板和软骨损伤的发生率较高，需要更多高质量的研究来得出关于这些患者 ACL 手术后膝关节骨关节炎发展的明确结论。
IV 级。
