Jia YF, Wang HN, Xu LQ, Sun R. Treatment of anterior cruciate ligament injuries in older adults: A clinical review. World J Orthop 2026; 17(10): 125554 [DOI: 10.5312/wjo.125554]
Corresponding Author of This Article
Ran Sun, MD, PhD, Professor, Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang 050051, Hebei Province, China. sunran1977@126.com
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Orthopedics
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review-article
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Jia YF, Wang HN, Xu LQ, Sun R. Treatment of anterior cruciate ligament injuries in older adults: A clinical review. World J Orthop 2026; 17(10): 125554 [DOI: 10.5312/wjo.125554]
World J Orthop. Oct 18, 2026; 17(10): 125554 Published online Oct 18, 2026. doi: 10.5312/wjo.125554
Treatment of anterior cruciate ligament injuries in older adults: A clinical review
Yan-Feng Jia, Hao-Nan Wang, Li-Qun Xu, Ran Sun
Yan-Feng Jia, Li-Qun Xu, Department of Orthopaedic Surgery, Jingjiang People’s Hospital Affiliated to Yangzhou University, Taizhou 214500, Jiangsu Province, China
Hao-Nan Wang, Ran Sun, Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei Province, China
Author contributions: Jia YF was involved in the conception and design of the study, data collection, and manuscript drafting; Sun R proposed the study concept, and critically revised the manuscript; Xu LQ contributed to the drafting and revision of the manuscript; Wang HN participated in data analysis and interpretation, and manuscript revision. All authors approved the final version to publish.
AI contribution statement: Portions of this manuscript were edited using AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Supported by Medical Talents Training Program of the Health Commission of Hebei Province, No. ZF2026179; Jingjiang People’s Hospital Hospital-Level Scientific Research Fund Project, No. JRY-KY-2026-022; and Medical Scientific Research Project of the Health Commission of Hebei Province, No. 20230684.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Ran Sun, MD, PhD, Professor, Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang 050051, Hebei Province, China. sunran1977@126.com
Received: July 15, 2026 Revised: August 1, 2026 Accepted: September 18, 2026 Published online: October 18, 2026 Processing time: 98 Days and 17 Hours
Abstract
The anterior cruciate ligament (ACL) is essential for knee joint stability. Although ACL injuries primarily affect young and middle-aged athletes, their incidence among older adults is increasing. Substantial or complete ACL rupture may cause persistent instability despite conservative treatment; in such cases, ACL reconstruction (ACLR) surgery is generally considered the standard surgical treatment. Because older adults often have osteoporosis, joint degeneration, and comorbidities, as well as lower functional demands than younger patients, some surgeons recommend conservative treatment. However, recent studies have found that patients who undergo ACLR and ACL repair have better postoperative functional recovery than those who receive conservative treatment, although there remains no clear consensus regarding the optimal treatment. This review examines the characteristics of ACL injuries in older adults and compares treatment methods, with the aim of improving the management of these patients. Current evidence indicates that older adults who undergo ACLR achieve comparable functional outcomes to younger patients, suggesting that treatment decisions should focus on functional needs and overall health rather than age or comorbidities alone. All-inside techniques may provide better outcomes in older adults, while supplementary reinforcement fixation may benefit patients with osteoporosis.
Core Tip: Advanced age, generally defined as ≥ 50 years, is no longer considered a contraindication to surgical treatment of anterior cruciate ligament (ACL) injuries. ACL reconstruction, particularly using all-inside techniques, can achieve outcomes in older adults comparable to those in younger patients. Less-invasive ACL repair may be appropriate for selected patients with proximal ACL tears. Treatment decisions should be based on activity level, functional demands, comorbidities, and the extent of knee degeneration rather than chronological age alone.
