HAMSTRING LIGAMENTOPLASTY AFTER 50 YEARS

Abstract

Purpose of the study: The hypothesis of this study was that age over 50 years is not a contraindication for hamstring reconstruction of the anterior cruciate ligament (ACL).

Material and methods: Study period: September 1998 to September 2003. Type of study: prospective, consecutive series. The patient included in this study met the following criteria: age over 50 years at surgery; chronic anterior laxity, alone or associated with meniscal injury; one or more episodes of instability; absence of preoperative medial femorotibial osteoarthritis; no prior history of ligament surgery on the same knee. The same technique was used for all patients: four-strand single fiber arthroscopic hamstring ligamentoplasty using a blind femoral tunnel drilled via an anteromedial arthroscopic portal. All grafts were fixed with resorbable screws in the femur and tibia. The same rehabilitation protocol was used for all patients. IKDC scores were recorded. Plain x-rays were obtained (single leg stance ap and lateral views) as well as 30° patellar and passive Lachman (Telos).

Results: Eighteen patients were included, 12 women, mean age 59.5 years (range 51–66 years. Mean follow-up was 35 months (range 12–59 months). There were no cases of recurrent ACL tears, no loss of extension. Three patients complained of hpoesthesia involving the internal saphenous nerve and two patients presented postoperative knee pain. At last follow-up, the overall IKDC score was 7A, and 11B. All patients considered they had a normal or nearly normal knee. All were satisfied or very satisfied. None of the patients presented instability. The Lachman-Trillat test was hard stop in 13 cases and late hard stop in 5. The pivot test was negative in 16 knees and questionable in two. Mean residual differential laxity was 3.3 mm (range −1 mm to +7 mm) in passive Lachman. There was no evidence of osteoarthritic progression on the x-rays.

Discussion and conclusion: This series demonstrated that age over 50 years is not a contraindication for arthroscopic hamstring ACL grafting. This operation can be used to restore knee stability.