Micicoi Grégoire, Fairag Rayan, Machado Axel, Douiri Adil, Bronsard Nicolas, Ernat Justin, Gonzalez Jean-François
Institut Universitaire Locomoteur et du Sport (iULS), Hôpital Pasteur 2, Nice, France.
Orthopaedic Center, University of Utah Health, Salt Lake City, Utah, USA.
Orthop J Sports Med. 2024 Dec 2;12(12):23259671241292071. doi: 10.1177/23259671241292071. eCollection 2024 Dec.
Anterior cruciate ligament (ACL) reconstruction is increasingly being performed in patients >50 years old; however, the long-term outcomes are unclear.
To analyze the functional results, osteoarthritic progression, reoperation rate, and failure rate at minimum 10-year follow-up in patients >50 years old who have undergone primary ACL reconstruction.
Case series; Level of evidence, 4.
Included in this study were patients >50 years old who underwent primary ACL reconstruction and had at least 10 years of follow-up data. All patients had instability with limitation of their activities, indicating the necessity of surgical intervention. Patients with revision surgeries, ACL repairs, and nonoperative treatment were excluded. Failure was defined as the presence of revision, high-grade Lachman, positive pivot shift (2+), or subjective instability. The Knee injury and Osteoarthritis Outcome Score (KOOS), subjective and objective functional scores, and osteoarthritic progression were analyzed at final follow-up.
A total of 38 patients were identified. The mean age at surgery was 56.8 ± 5.7 years (range, 50.6-70 years). The mean clinical follow-up was 16.2 ± 4.3 years (range, 10.9-23.3 years). The failure rate was 10.5% (4/38): 1 of the 4 patients had a recurrence of instability at 13 years postoperatively and underwent revision with a modified Lemaire extra-articular tenodesis, 1 patient had a positive pivot shift (2+) without subjective instability, and 2 patients underwent total knee arthroplasty. The overall KOOS was 74.2 ± 22.2, and 91.4% of patients were satisfied or very satisfied with the results of the procedure. Radiographic osteoarthritis was identified in 88.5% of patients at final follow-up; however, there was no statistical significance on clinical outcomes ( > .05). Concomitant partial medial meniscectomy ( < .01) and meniscal repair ( < .01) were associated with the presence of Ahlbäck grade 3 or 4 osteoarthritic manifestations.
In patients over the age of 50 years who underwent primary ACL reconstruction, there was a low long-term failure rate and a high level of patient satisfaction, despite osteoarthritic progression in 88.5% of cases. Concomitant meniscal procedures were associated with more severe osteoarthritic progression.
前交叉韧带（ACL）重建术在50岁以上患者中的应用越来越广泛；然而，其长期疗效尚不清楚。
分析50岁以上接受初次ACL重建术患者至少10年随访的功能结果、骨关节炎进展情况、再次手术率和失败率。
病例系列；证据等级，4级。
本研究纳入了50岁以上接受初次ACL重建术且有至少10年随访数据的患者。所有患者均存在活动受限的不稳定情况，表明有手术干预的必要性。排除接受翻修手术、ACL修复和非手术治疗的患者。失败定义为存在翻修、高级别拉赫曼试验阳性、阳性轴移试验（2+）或主观不稳定。在末次随访时分析膝关节损伤和骨关节炎疗效评分（KOOS）、主观和客观功能评分以及骨关节炎进展情况。
共纳入38例患者。手术时的平均年龄为56.8±5.7岁（范围50.6 - 70岁）。平均临床随访时间为16.2±4.3年（范围10.9 - 23.3年）。失败率为10.5%（4/38）：4例患者中有1例术后13年出现不稳定复发，接受了改良勒梅尔关节外肌腱固定翻修手术；1例患者轴移试验阳性（2+）但无主观不稳定；2例患者接受了全膝关节置换术。总体KOOS评分为74.2±22.2，91.4%的患者对手术结果满意或非常满意。在末次随访时，88.5%的患者存在影像学骨关节炎；然而，对临床结果无统计学意义（P＞0.05）。同时进行部分内侧半月板切除术（P＜0.01）和半月板修复术（P＜0.01）与阿尔贝克3级或4级骨关节炎表现相关。
在50岁以上接受初次ACL重建术的患者中，尽管88.5%的病例出现了骨关节炎进展，但长期失败率较低，患者满意度较高。同时进行半月板手术与更严重的骨关节炎进展相关。
