title: Patellar tendon or hamstring graft anterior cruciate ligament reconstructions in patients aged above 50 years.
abstract: BACKGROUND
  The treatment of anterior cruciate ligament (ACL) injury consists of arthroscopic ACL reconstruction with patellar tendon or hamstring graft. Satisfactory results have been reported so far in the younger age group. Dilemma arises regarding the suitability of ACL reconstruction in patients aged 50 years and above. This retrospective analyses the outcome of ACL reconstruction in patients aged 50 years and above.
  
  
  METHODS
  55 patients aged 50 years and above presented to our institution with symptomatic ACL tear and were managed with arthroscopic reconstruction with patellar tendon/hamstring graft. 22 patients underwent ACL reconstruction with bone- patellar tendon-bone graft and the remaining 33 with a hamstring graft. Evaluation of functional outcome was performed using International Knee Documentation Committee (IKDC) and Lysholm scoring in the preoperative period, at the end of 1 year and at the final followup. Radiographic evaluation was performed using the Kellgren-Lawrence grading system.
  
  
  RESULTS
  The mean preoperative IKDC score was 39.7 ± 3.3. At the end of 1-year following the operation, the mean IKDC score was 73.6 ± 4.9 and at the final followup was 67.8 ± 7.7. The mean preoperative Lysholm score was 40.4 ± 10.3. At the end of 1-year following the intervention, the mean Lysholm score was 89.7 ± 2.1 and at final followup was 85.3 ± 2.5. Overall, 14 out of 42 patients who underwent radiographic assessment showed progression of osteoarthritis changes at the final followup after the intervention.
  
  
  CONCLUSIONS
  In our study, there was a statistically significant improvement in the IKDC and Lysholm scores following the intervention. There was a slight deterioration in the scores at the final followup but the overall rate of satisfaction was still high and most of the patients were able to do their routine chores and light exercises suitable for their age group. Around one-third of patients show progression of radiographic changes in the postoperative period and this requires long term evaluation.
authors.affiliation: Department of Orthopaedics, HOSMAT Hospital, Bengaluru, Karnataka, India.
authors.forename: Tarun
authors.initials: T
authors.lastname: Bali
authors.affiliation: Department of Orthopaedics, HOSMAT Hospital, Bengaluru, Karnataka, India.
authors.forename: Raghu
authors.initials: R
authors.lastname: Nagraj
authors.affiliation: Department of Orthopaedics, HOSMAT Hospital, Bengaluru, Karnataka, India.
authors.forename: Malhar N
authors.initials: MN
authors.lastname: Kumar
authors.affiliation: Department of Orthopaedics, HOSMAT Hospital, Bengaluru, Karnataka, India.
authors.forename: Thomas
authors.initials: T
authors.lastname: Chandy
keywords: Anterior cruciate ligament; Bone patellar tendon- bone graft; International Knee Documentation Committee; anterior cruciate ligament; anterior cruciate ligament reconstruction; arthroscopy; articular; grafts; hamstring; ligaments