Reconstruction of the anterior cruciate ligament using a four-strand hamstring tendon autograft in symptomatic patients aged 50years or older is an accepted treatment option.

Four-strand hamstring tendon autograft although not universally utilized in patients who are at least 50years old is an efficient procedure to control knee instability.

In this retrospective, we analyzed the clinical outcomes of 18patients treated from September 1998 to September 2003. Criteria for inclusion were the following: age above 50years at surgery, chronic anterior laxity associated or not with meniscal damage; one or more episodes of knee instability and no prior ligament surgery on the involved knee. A same operative technique (arthroscopic single-bundle four-strand hamstring reconstruction, blind femoral tunnel, through anteromedial portals), a same fixation type (absorbable interference screws in femur and tibia) and a same rehabilitation protocol were used for all these knees. The IKDC 93scores were determined pre- and postoperatively combined with anteroposterior and lateral views, single leg stance, 30° flexion stance, and passive Lachman test (Telos) postoperatively.

At mean 30month-follow-up (range 12–59months), there were no graft failure and no loss of extension for any of these knees. Three patients complained of hypoesthesia in the medial saphenous nerve territory and one patient experienced posterior knee pain. All patients graded their knee as normal or nearly normal, all were satisfied or very satisfied with their operation. None of the patients reported instability. The Lachman-Trillat test was noted “firm end point” in 14knees and “delayed firm end point” in four. The pivot-shift test was negative in 16knees and mild positive in two. The mean residual differential laxity was 3.1mm (0 to +6mm) for the passive Lachman test. At last follow-up, the overall IKDC score was 7A, 7B, 3C, and 1 D. Patients with preserved meniscus (nine patients) reported a lesser degree of pain and a better residual laxity control compared with patients who had undergone a meniscectomy.

Age over 50years is not a contraindication to select a hamstring tendon autograft for ACL reconstruction. This surgery can restore knee stability but does not modify the pain pattern in patients, who had a medial meniscectomy prior to the ACL reconstruction.

Level of evidence: level IV, therapeutic study.