Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Via Giovanni Paolo II, 86100, Campobasso, Italy.
Sports Medicine Center, The Shoulder Center of Kentucky, Lexington, USA.
Knee Surg Sports Traumatol Arthrosc. 2020 Jun;28(6):1932-1945. doi: 10.1007/s00167-019-05680-3. Epub 2019 Aug 28.
The aim of the present meta-analysis was to update the literature on the outcomes and complications of ACL reconstruction in patients aged 40 years and older. It has been hypothesized that patients older than 40 years of age may have comparable clinical outcomes to those of younger patients.
A systematic review of articles from 1996 to 2018 was completed using Pubmed, Medline, Cochrane Reviews, and Google Scholar databases using the keyword terms "anterior cruciate ligament reconstruction" and "middle-aged OR elderly OR over 40 OR age factors." Functional and clinical outcomes (International Knee Documentation Committee, Lysholm and Tegner score and KT-1000 arthrometer), complication and graft failure rate were evaluated.
Eleven articles met inclusion criteria. In total, 306 middle-aged patients and 566 younger patients were included in this study. The mean age of patients > 40 was 49 ± 7 (range 40-75) years with a mean follow-up of 25 ± 9 months (range 12-68). The mean age of younger patients was 26 ± 2.7 (range 15-39) years with a mean post-operative follow-up of 26.7 ± 11.5 months (range 3-64). The results were slightly higher (but no significantly different) towards the younger group in terms of objective IKDC (P = n.s.), Lysholm (P = n.s.) and Tegner (P = n.s.) scores and knee laxity assessment (P = n.s.). Complication rate (P = n.s.) and graft failure (P = n.s.) were low even in this cohort.
The present meta-analysis shows that patients older than 40 years achieve comparable clinical outcomes to those of younger patients following primary ACL reconstruction. This evidence may push the surgeons toward a more aggressive approach in this specific cohort of patients.
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本荟萃分析旨在更新关于 40 岁及以上患者前交叉韧带重建（ACL）手术结果和并发症的文献。研究假设 40 岁以上患者的临床结果可能与年轻患者相当。
通过使用 Pubmed、Medline、Cochrane 综述和 Google Scholar 数据库，使用“前交叉韧带重建”和“中年或老年或 40 岁以上或年龄因素”等关键词词检索 1996 年至 2018 年的文献，完成系统评价。评估了功能和临床结果（国际膝关节文献委员会、Lysholm 和 Tegner 评分和 KT-1000 关节测量仪）、并发症和移植物失败率。
11 篇文章符合纳入标准。共有 306 名中年患者和 566 名年轻患者纳入本研究。>40 岁患者的平均年龄为 49 ± 7 岁（范围 40-75 岁），平均随访时间为 25 ± 9 个月（范围 12-68 个月）。年轻患者的平均年龄为 26 ± 2.7 岁（范围 15-39 岁），平均术后随访时间为 26.7 ± 11.5 个月（范围 3-64 个月）。在客观 IKDC（P=n.s.）、Lysholm（P=n.s.）和 Tegner（P=n.s.）评分以及膝关节松弛度评估方面，年轻组的结果略高（但无统计学差异）。并发症发生率（P=n.s.）和移植物失败率（P=n.s.）在该队列中也较低。
本荟萃分析表明，40 岁以上患者行 ACL 重建后可获得与年轻患者相当的临床结果。这一证据可能促使外科医生对这一特定患者群体采取更积极的治疗方法。
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