Sports and exercise are an important part of life for more people than ever. This fact applies to people later in life that still want to play golf or tennis, run marathons, or compete in triathlons. We shouldn’t be surprised that when older people suffer an injury, they often want to treat it in a way that allows them to return to their activities.
For decades, ACL reconstruction has traditionally been a surgery done for athletes – high school, college and professional athletes and young adult weekend warriors. When I was an orthopaedic surgery resident, I asked the different sports medicine surgeons what was the age of the oldest patient in whom they had performed ACL reconstruction. The answer was 47.
Argument against ACL surgery in older patients
Essentially the argument went something like this. As people get older, they generally stop playing sports or doing exercise that involves landing from a jump or cutting maneuvers. They wouldn’t feel the instability from an ACL-deficient knee. And despite the ACL tear, they can usually return to jogging and most exercise without surgery. Plus some surgeons worry about knee stiffness after ACL reconstruction in older patients.
I’ve done a handful of ACL surgeries in patients in their late 50s early 60s so far in my career. Honestly, I’ve been pleased with their results. They have worked really hard, and they have all returned to their sports (tennis, golf, martial arts) or forms of exercise. To be fair, though, that is anecdotal evidence.
New study reviews ACL reconstruction in patients 60 and older
A new study published in the Orthopaedic Journal of Sports Medicine reviews data from 15 patients in whom the authors performed ACL reconstruction between 1984 and 2010. All of the patients had active lifestyles that included sports and exercise such as running, skiing and tennis. The 13 patients available for follow-up averaged 63.5 years old. All but one of these patients underwent surgery because they felt the knee was unstable.
Generally all 13 patients in their study had good results. One patient fell and reinjured the ACL, requiring revision ACL reconstruction. All of them said they were happy with their knees at an average of close to 10 years after surgery. Based on modified Cincinnati Knee Scores, seven had excellent results, five had good results, and one had a fair result. All 13 said they would choose to have the surgery again.
This is a small sample, and it is not a randomized controlled trial, so you can’t conclude that they did better after surgery than they might have done without it. Since they were having knee instability before surgery, though, they might have had poor outcomes with nonoperative treatment. Given that they were active people, they might not have returned to sports or exercise.
If it proves anything, the study suggests that ACL reconstruction can at least be a reasonable option for older patients with torn ACLs, especially if they have feelings that their knees buckle or give way with activity. It is a long recovery after surgery, just like it is for high school and college athletes, but it can be a good option for any active patient.
Baker CL, Jones JC, Zhang J. Long-term Outcomes After Anterior Cruciate Ligament Reconstruction in Patients 60 Years and Older. The Orthopaedic Journal of Sports Medicine, 2(12).