Management of anterior cruciate ligament (ACL) injuries in adults aged >40 years has received increased attention in the literature because of an increase in the functional demands of aging athletes. Multiple structural and biomechanical age-dependent changes exist in the ACL, for example, fewer mesenchymal stem cells, decreased healing potential, decreased structural organization, decreased stiffness, and a decreased load to failure with age. As in younger patients, ACL insufficiency can predispose an older patient to the same risks of recurrent instability, meniscal and chondral injury, and osteoarthritis. The role of nonsurgical versus surgical management in these patients remains controversial. Lower-demand patients may be able to cope with ACL deficiency. Higher-demand patients may have functional instability, and the limited studies available suggest good functional outcomes with surgical reconstruction of the ACL in this population.
From Department of Orthopaedics, Tufts Medical Center, Boston, MA (Dr. Salzler), the Department of Orthopedics, University of Colorado at Denver, Anschutz Medical Campus, Aurora, CO (Dr. Chang), and Boston Sports and Shoulder Center, New England Baptist Hospital, Waltham, MA (Dr. Richmond).
Dr. Salzler or an immediate family member is a board member or committee member of the American Orthopaedic Society for Sports Medicine. Dr. Richmond or an immediate family member serves as a paid consultant to Histogenics, Mitek, and Visgo Therapeutics; has received royalties and financial or material support from Springer and Wolters Kluwer Health–Lippincott Williams & Wilkins; and is a board member or committee member of the Arthroscopy Association of North America and Eastern Orthopaedic Education Foundation. Neither Dr. Chang nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.