Treatment of anterior cruciate ligament injuries in older adults: A clinical review

Table 1 Objective to compare the results of non-surgical treatment, anterior cruciate ligament repair and anterior cruciate ligament reconstruction in older adults

Outcome metric	Non-operative treatment	ACL repair	ACL reconstruction
Patient selection	Low activity demand, no instability, surgical contraindications	Acute proximal femoral-side tears	Most surgical candidates, including chronic tears and midsubstance tears
Knee stability restoration	Poor (83% rotational instability persists)[8]	Good in selected patients	Excellent and predictable
Return to pre-injury activity	Limited (pivot activities almost infeasible)[6]	Moderate, depends on selection	Approximately 64%[9]
Failure/re-rupture rate	33%-60% eventually require surgery[23]	Approximately 6% in older adults (age-dependent)[12]	0.3%-7.1%[9]
10-year survival	N/A	Limited long-term data	82.4% (≥ 50 years)[31]
Conversion to TKA	Not well documented	Limited data	Limited data
Advantages	Avoids surgical risks	Preserves native ligament, less invasive, bone stock preservation	Most predictable outcomes, applicable to all tear types
Limitations	High failure rate, persistent instability	Strict selection required, limited evidence	More invasive, graft-related morbidity, OA risk

TKA: Total knee arthroplasty; OA: Osteoarthritis; ACL: Anterior cruciate ligament; N/A: Not applicable.