Clinical outcomes and failure rates of combined 'Over-the-Top' anterior cruciate ligament reconstruction and lateral extra-articular tenodesis in a cohort of patients with an average age of 60 years.

PURPOSE: The management of anterior cruciate ligament (ACL) tears in older adults remains controversial, although recent evidence suggests an increasing trend toward surgical treatment. To date, no studies have specifically investigated the outcomes of combined ACL reconstruction (ACLR) with over-the-top (OTT) technique and lateral extra-articular tenodesis (LET) in this population. The aim of this study was to evaluate clinical outcomes and failure rates of ACLR using OTT plus LET in patients aged 55 years or older. METHODS: Patients aged ≥55 years who underwent primary ACLR with OTT and LET techniques and had a minimum follow-up of 2 years were included. Clinical outcomes were assessed using clinical scores, such as VAS, Lysholm, KOOS, comparing preoperative and post-operative values. Patient Acceptable Symptom State (PASS) thresholds were applied to KOOS subscales. Reoperations and graft failures were also recorded. RESULTS: Twenty-eight patients met the inclusion criteria, with a mean age of 60.1 ± 3.2 years and a mean follow-up of 6.5 ± 3.8 years. One graft failure (3.6%) and one reoperation (3.6%) were observed. Significant improvements were noted in all clinical scores. The mean Lysholm score increased from 55.4 ± 15.9 preoperatively to 96.6 ± 6.6 postoperatively. KOOS subscales showed marked improvement, particularly in Quality of Life (41.6 ± 20.2 to 90.3 ± 12.9) and Pain (68.7 ± 12.1 to 94.2 ± 5.7). CONCLUSION: ACLR with OTT and LET techniques in older patients demonstrated low failure rates and favourable clinical outcomes. Larger studies are needed to confirm these findings and to establish the role of this combined technique in this population. LEVEL OF EVIDENCE: Level IV.