NONOPERATIVE TREATMENT OF RUPTURES OF THE ANTERIOR CRUCIATE LIGAMENT IN MIDDLE-AGED PATIENTS - RESULTS AFTER LONG-TERM FOLLOW-UP

We retrospectively reviewed the records of fifty-two patients,who had had a rupture of the anterior cruciate ligament between the ages of fo rty and sixty years, to determine the results of aggressive non operat ive treatment. We were able to locate and re-examine thirty of these p atients (mean age, forty-six years) after a mean duration of follow-up of seven years (range, five to thirteen years), and to assess the cli nical, radiographic, and functional results. The mean score, according to the scale of Lysholm and Gillquist, was 82 points; eight of the el even patients who had combined ligamentous injuries had a score of les s than 84 points (symptoms with daily activities). Thirteen substantia l reinjuries had occurred in eleven patients (37 per cent) during the follow-up period. Twenty-nine patients (97 per cent) had a grade-2 or 3 Lachman test, and a positive pivot-shift test was elicited in twenty -five patients (83 per cent). Plain radiographs revealed minimum or no changes in twenty-six patients (87 per cent). Magnetic resonance imag ing in nine patients revealed scarring of the remnant of the anterior cruciate ligament to the posterior cruciate ligament in six. The mean difference in anterior-posterior laxity between the injured knee and t he normal, contralateral knee, as measured with the KT-1000 arthromete r, was five millimeters at twenty pounds (eighty-nine newtons). Twenty -five (83 per cent) of these thirty middle-aged patients, who had had guided rehabilitation and had modified activity, had a satisfactory ou tcome without an operation. However, a few patients, who had combined instabilities and who wished to resume competitive sports activity tha t required pivoting, were dissatisfied. Such patients may need operati ve reconstruction to achieve their goals.