Department of Orthopaedic Surgery, Chiba Medical Center, Chiba, Japan.
Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Am J Sports Med. 2022 Jan;50(1):93-102. doi: 10.1177/03635465211059158. Epub 2021 Nov 26.
Thus far, the clinical results of anterior cruciate ligament (ACL) reconstruction have been observed to be comparable between young and older patients. In contrast, age-related changes in the structural and mechanical properties of tendons used for autografts have been described. However, age-related changes associated with graft maturation remain poorly understood.
The hypotheses of this study were that (1) clinical outcomes after ACL reconstruction would be comparable between younger and relatively older patients and (2) younger patients would show lower signal intensity changes on magnetic resonance imaging scans indicative of graft maturation that would be better than that in relatively older patients.
Cohort study; Level of evidence, 3.
We retrospectively evaluated 236 patients who underwent double-bundle ACL reconstruction via the outside-in technique using hamstring autograft between January 2012 and December 2015. The patients were categorized by age into 3 groups: <20 years old, 20 to 39 years old, and ≥40 years old. Clinical outcomes were evaluated using the subjective International Knee Documentation Committee (IKDC) score, Tegner activity scale, Lysholm score, and objective assessment of joint laxity 24 months after surgery. In addition, graft maturation was evaluated using magnetic resonance imaging-derived measures of the signal intensity ratio (SIR) at 3, 6, 12, and 24 months postoperatively. Clinical outcomes and graft maturation were compared among the 3 groups.
The SIR of both bundles increased from 3 months to 12 months and decreased by 24 months, showing the same tendency in all groups. No significant difference was found in the SIR among the 3 groups at any time point ( > .05). The IKDC score was significantly lower in the ≥40-year group than in the <20-year group ( < .01). In contrast, no significant differences were noted in other clinical outcomes.
Patients aged ≥40 years exhibited lower IKDC scores compared with younger patients, although the results of graft maturation were comparable.
迄今为止，前交叉韧带（ACL）重建的临床结果在年轻患者和老年患者之间已被观察到相似。相比之下，已描述了用于自体移植物的肌腱的结构和机械性能随年龄的变化。然而，与移植物成熟相关的年龄相关变化仍知之甚少。
本研究的假设是：（1）ACL 重建后，年轻患者和相对较老的患者的临床结果将相似，（2）年轻患者的磁共振成像（MRI）扫描显示的移植物成熟的信号强度变化将低于相对较老的患者，且改善情况更好。
队列研究；证据水平，3 级。
我们回顾性评估了 2012 年 1 月至 2015 年 12 月期间采用双束外-内技术使用腘绳肌自体移植物进行 ACL 重建的 236 例患者。患者按年龄分为 3 组：<20 岁、20-39 岁和≥40 岁。临床结果通过主观国际膝关节文献委员会（IKDC）评分、Tegner 活动量表、Lysholm 评分和术后 24 个月关节松弛的客观评估进行评估。此外，术后 3、6、12 和 24 个月，通过 MRI 测量信号强度比（SIR）评估移植物成熟度。比较了 3 组之间的临床结果和移植物成熟度。
在所有组中，双束的 SIR 均从 3 个月增加到 12 个月，然后在 24 个月时下降，呈现出相同的趋势。在任何时间点，3 组之间的 SIR 均无显着差异（>.05）。≥40 岁组的 IKDC 评分明显低于<20 岁组（<.01）。相比之下，其他临床结果没有差异。
与年轻患者相比，≥40 岁的患者的 IKDC 评分较低，但移植物成熟的结果相似。
