ACL Surgery: Options for Ligament Reconstruction in Older Adults - Orthopedics

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Posterior cruciate ligament surgery


Hello Doctor, about 17 years ago I had a motorcycle accident.
After healing, I experienced pain in my left knee when running abruptly.
At that time, I went to Linkou Chang Gung Memorial Hospital for an examination, and the doctor diagnosed a torn anterior cruciate ligament (ACL), but since it did not affect my daily life, I did not undergo ligament repair.
However, I experience pain after prolonged squatting or intermittent pain in my left knee.
If I wish to undergo ligament repair now, considering my current age, would it be advisable to use an autograft for reconstruction, or would you recommend using an artificial ligament? Thank you for your assistance.

Liang Xiansheng, 40~49 year old female. Ask Date: 2023/03/13

Dr. Shi Guozheng reply Orthopedics


Typically, individuals over the age of forty who do not require intense physical activity may not need reconstructive surgery.
Pain can be managed with medication or by wearing a knee brace.
If there is severe degeneration of the knee joint, it is advisable to wait until they are older before considering joint replacement surgery.

Reply Date: 2023/03/13

More Info


When considering ACL (anterior cruciate ligament) surgery for older adults, particularly those who have experienced knee pain and instability, several factors must be taken into account. Given your history of a knee injury from a motorcycle accident 17 years ago, and the subsequent pain during activities such as running or prolonged squatting, it is understandable that you are exploring options for ligament reconstruction.


Options for ACL Reconstruction
1. Autograft (Using Your Own Tissue): This is the most common method for ACL reconstruction. In this procedure, a surgeon takes a portion of your own tendon (often from the patellar tendon, hamstring tendon, or quadriceps tendon) to replace the damaged ACL. The advantages of using an autograft include better integration with the body and a lower risk of rejection. However, it does involve a second surgical site, which can lead to additional pain and recovery time.

2. Allograft (Using Donor Tissue): An allograft involves using tissue from a deceased donor. This option can reduce recovery time since there is no need to harvest tissue from your body. However, there is a slightly higher risk of complications, such as infection or graft rejection, although these risks are generally low. Allografts may also have a different healing timeline compared to autografts.


Considerations for Older Adults
As we age, the healing process can slow down, and the quality of the tissue may not be as robust as in younger individuals. This can affect the choice of graft:
- Age and Activity Level: If you are relatively active and wish to return to sports or high-impact activities, an autograft may provide a more stable and durable solution. However, if your activity level is lower and you are primarily looking for pain relief and improved function in daily activities, an allograft may suffice.

- Comorbidities: Any existing health conditions, such as cardiovascular issues or diabetes, can affect surgical outcomes and recovery. It is crucial to discuss these with your healthcare provider.

- Knee Condition: If there is significant arthritis or other degenerative changes in the knee, this may influence the decision. In some cases, additional procedures, such as a partial knee replacement or osteotomy, may be recommended alongside ACL reconstruction.


Risks and Recovery
Both types of grafts come with risks, including infection, blood clots, and complications related to anesthesia. Recovery typically involves physical therapy and rehabilitation, which can be more challenging for older adults. The goal is to restore function and reduce pain, but the timeline for recovery may be extended compared to younger patients.


Conclusion
In your case, given the history of knee pain and instability, it would be advisable to consult with an orthopedic surgeon who specializes in sports medicine or knee surgery. They can assess your knee's current condition through imaging studies and physical examination, and help you weigh the pros and cons of autograft versus allograft based on your specific situation, age, activity level, and overall health.
Ultimately, the decision should be made collaboratively, considering your personal goals for recovery and activity post-surgery. It is essential to have realistic expectations and understand that while surgery can significantly improve function and reduce pain, it may not restore the knee to its pre-injury state.

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