Clinical and functional outcome of anterior cruciate ligament reconstruction in the recreational athlete over the age of 35.

This study examined the functional, objective, and subjective outcome of anterior cruciate ligament (ACL) reconstruction in recreational athletes > or = 35 years after a minimum of 2 years of follow-up. Patients > or = 35 years who underwent ACL reconstruction by a single surgeon were identified from our surgical database. Nineteen knees in 18 (62% follow-up) patients were available for review by an independent examiner. The patients underwent physical examination, radiographs, functional testing, isokinetic strength testing, and instrumented ligament arthrometer testing. All were seen at a minimum of 2 years of follow-up. The average age was 40 years. Five of 19 underwent reconstruction less than 1 month after injury, and the remainder underwent reconstruction for chronic injuries. All patients preoperatively had at least a grade 2 Lachman and a positive pivot shift noted on physical examination. After a minimum of 2 years of follow-up, 17 of 18 patients had a stable knee on objective testing, including a negative Lachman and pivot shift. Seventeen patients (94%) had < 3 mm side-to-side difference on maximum manual arthrometric testing. Only one patient had > 3 cm prone heel height difference, and all patients had > 125 degrees of flexion. Mean thigh circumference difference was 0.5 cm. Isokinetic testing demonstrated a mean 11%, 7%, and 4% quadriceps asymmetry at 60 degrees, 180 degrees, and 240 degrees/second, respectively. However, functional testing revealed only a mean 6% asymmetry on vertical jump, single leg hop, and timed 6 meter hop. Seventeen of 18 patients were satisfied with their results. The mean postoperative Lysholm Rating Scale score was 93. The mean Noyes Sports Activity Scale score was 86, improved from 31 preoperatively. Thirteen of 18 returned to their preinjury level of sports performance. These results indicate that ACL reconstruction in patients over the age of 35 has functional, objective, and subjective results comparable to those of a younger patient population.