title: Single- and double-bundle anterior cruciate ligament reconstruction in patients aged over 50 years.
abstract: OBJECTIVE
  The purpose of our study was to retrospectively evaluate the outcomes after anterior cruciate ligament (ACL) reconstruction with hamstring in patients aged 50 years or older. In addition, we present, for the first time, the outcomes of a subgroup of middle-aged patients treated with double-bundle (DB) reconstruction.
  
  
  METHODS
  Fifty patients aged 50 years or older underwent primary ACL reconstruction with hamstring. Inclusion criteria were primary ACL reconstruction in active patients. Exclusion criteria were multiligamentous injuries and a contralateral ACL-deficient knee. The mean age at surgery was 54.4 years (range, 50 to 65 years). The mean period from the initial injury to surgery was 32.6 months (range, 3 to 125 months). Of the patients, 36 underwent single-bundle (SB) ACL reconstruction and 14 underwent DB reconstruction. Patients were assessed preoperatively with physical examination (including range of motion, pivot-shift test, and instrumented knee laxity measurement), the Lysholm score, the International Knee Documentation Committee scoring system, and the Tegner activity scale. Standard radiographs were taken, and degenerative changes were graded according to the Ahlbäck radiologic classification of arthritis.
  
  
  RESULTS
  Patients were evaluated at a mean of 4.4 years (range, 2 to 7 years) after surgery. A significant improvement in knee function and symptoms was reported in most patients, with increased Lysholm, International Knee Documentation Committee, and Tegner scores (P < .001). The outcomes of clinical assessment and instrumented laxity testing were clearly improved when compared with preoperative status (P < .001). The level of osteoarthritis did not statistically increase at follow-up. No statistically significant difference could be observed between the SB and DB groups (P = not significant).
  
  
  CONCLUSIONS
  Operative treatment showed favorable outcomes in most of the ACL-reconstructed patients with regard to knee stability, osteoarthritis progression, and patient satisfaction in a cohort of subjects aged 50 years or older. Our subgroup of patients undergoing DB ACL reconstruction reported average satisfactory outcomes, which did not significantly differ from the SB group.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Minimally Invasive Articular Surgery Unit, Istituto Ortopedico G. Pini, Milan, Italy. alberto.ventura@doctoral.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Ventura
authors.forename: Claudio
authors.initials: C
authors.lastname: Legnani
authors.forename: Clara
authors.initials: C
authors.lastname: Terzaghi
authors.forename: Enrico
authors.initials: E
authors.lastname: Borgo
mesh_terms: D000367:Age Factors; D000368:Aged; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001168:Arthritis / Q000150:complications / Q000000981:diagnostic imaging; D001182:Arthroscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000534:rehabilitation; D007718:Knee Injuries / Q000150:complications / Q000534:rehabilitation / Q000601:surgery*; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012421:Rupture / Q000601:surgery; D013710:Tendons / Q000637:transplantation; D016896:Treatment Outcome