A torn ACL has long been associated with high school athletes, weekend warriors, and professional athletes. However, increasingly, active adults in their 50s, 60s, and beyond are sustaining ACL tears when injured skiing, playinig pickleball, and doing other recreational activities. As a result, Dr. Richard Cunningham, board-certified orthopedic surgeon and sports medicine specialist at Vail-Summit Orthopaedics & Neurosurgery (VSON), is often asked whether someone is too old for ACL surgery?
“Age is a consideration, but more important, is whether patients are experiencing symptomatic instability,” says Dr. Cunningham. “We see a significant number of very active patients in their 60s and 70s who are inquiring about ACL surgery, as their knee instability is preventing them from staying engaged in the sports and lifestyle they love.”
Let’s explore how a torn ACL in older adults is treated, when surgery is appropriate, and what to expect during recovery.
Understanding ACL Tears in Older Adults
The anterior cruciate ligament (ACL) is one of the key stabilizing ligaments in the knee. It’s commonly torn during sudden stops, twists, or falls, many of which happen during sports like skiing, soccer, or pickleball. While older patients who sustained an ACL injury were once managed through non-surgical means, today’s active older patients often want a more durable, functional solution.
“There’s a big difference between an 18-year-old football player and a 65-year-old skier who tear their ACL,” Dr. Cunningham says. “Younger patients require an intact ACL to return to cutting and pivoting sports. As we get older, our joints get stiffer and therefore most older athletes do not need ACL surgery. However, some older athletes continue to be unstable and are unwilling to give up their cutting and pivoting sport. In these cases, they may need ACL reconstruction surgery.”
A torn ACL in older adults may be accompanied by other issues such as meniscus damage, cartilage wear and arthritis. A thorough evaluation is essential to determine the best path forward.
Who Should Consider ACL Surgery?
ACL surgery in an older person is not uncommon, but it’s not necessary for everyone. The decision depends on several key factors:
- Activity level: If you’re hoping to return to activities that involve pivoting, cutting, or impact (like skiing or basketball), ACL surgery may be needed to provide one with a stable knee.
- Stability: A knee that feels unstable or “gives out” during daily tasks may benefit from ACL repair.
- Pre-existing conditions: If an older patient had pre-existing arthritis in the knee that was causing pain and swelling and then they tore their ACL, Dr. Cunningham would not recommend ACL surgery. Rather, the patient would be better served with getting a knee replacement as then the arthritis is treated and with a knee replacement comes a mechanical ACL that also stabilizes the knee.
- Overall health: If an older patient had pre-existing health conditions (ie. heart disease, diabetes), then it probably is not indicated to have ACL surgery.
“For many of our active, older patients in Colorado, non-operative treatment may not allow them to resume the lifestyle they want to maintain,” Dr. Cunningham explains. “If they do not have serious medical issues, their knee has minimal arthritis, and they are experiencing knee instability or giving way episodes, then they may be a good candidate and do well with ACL surgery in order to provide long-term knee stability.”
Nonsurgical Options for ACL Tears
For less active older individuals or those with health conditions, conservative treatment can be effective. These options may include:
- Knee bracing for stability
- Physical therapy to strengthen surrounding muscles
- Activity modification
- Anti-inflammatory medications for a short period of time for pain and swelling
What to Expect from Surgery and Recovery
Modern ACL reconstruction uses minimally invasive techniques that promote faster healing and less postoperative pain. Recovery time is similar across age groups, but ACL rehabilitation in older adults may require more individualized treatment to account for losses in muscle mass and to improve flexibility.
Dr. Cunningham and his team work closely with each patient to develop a safe, customized plan.
“Our goal is to restore knee stability and confidence,” says Dr. Cunningham. “Whether that means hiking with grandkids or returning to the ski slopes, we support every step of that journey.”
With proper rehabilitation, many older adults regain full function, reduce pain, and return to high-level activity after surgery.
ACL Injury Care for Active Adults – Dr. Richard Cunningham, VSON
If you are an older, active adult who has recently torn your ACL and you are weighing the pros and cons of ACL surgery, Dr. Cunningham has 20+ years of experience treating ACL tears, and he is here to help. With a personalized approach, advanced surgical techniques, and a deep understanding of older ACL injury recovery, he helps patients return to their active lifestyle.
Contact Dr. Cunningham at Vail-Summit Orthopaedics & Neurosurgery today to schedule a consultation and take the next step toward long-term knee health.