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Meeting the "Kneeds" of the Over-40 Crowd

If you're young and injure the anterior cruciate ligament (ACL) in your knee, surgery is often advised. However, most doctors aren't so quick to suggest repair for patients over 40. The results of several new studies may change that.

Different tissue can be used to repair a torn ACL. Sometimes, this tissue is taken from a donor (allograft). Other times, the doctor takes part of the tendon (or tendon and bone) from around the patient's own knee to replace the ACL (autograft). This is the first study to look at patients over 40 who had ACL surgery using an allograft. 

Most of the time, middle-aged adults don't return to sports and activities at the same level as before the injury. Many are willing to modify their lifestyles. They are generally happy with the results even when giving up high-demand sports. The knee is usually stable, and they can function quite well in most activities.

There is one difference noted between young patients and middle-aged patients after ACL repair. This is the amount of wear and tear in the knee joint. X-rays two years after the ACL repair show more changes in the joints of the group over 40. The wear and tear may be from aging and daily wear over time. Often the older patient has a previous history of knee surgery to remove part or all of the meniscus, the protective cartilage within the knee joint.

So if you're over 40 when you injure or tear the ACL, don't despair. Surgery to repair this ligament using allograft is safe and effective for most patients. Two years after surgery, almost all of the 57 patients in this study said they would have the same operation again if they had to do it over again.

References: David K. Kuechle, MD, et al. Allograft Anterior Cruciate Ligament Reconstruction in Patients Over 40 Years of Age. In Arthroscopy. October 2002. Vol. 18. No. 8. Pp. 845-853.

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