For insight into the topic of meniscal transplantation (which, along with meniscal repair, is commonly needed in the context of ACL-injury-history knees, given that ACL injuries are very often accompanied by meniscal tearing) in people up to age 50, please see the July 2004 article Meniscal Transplantation in Symptomatic Patients Less Than Fifty Years Old, by Frank R. Noyes and Sue D. Barber-Westin, in the Meniscal Injuries: Causes, Consequences and Treatments Subsection.

Allograft Anterior Cruciate Ligament Reconstruction in Patients Over 40 Years of Age, David K. Kuechle et al.; Arthroscopy, The Journal of Arthroscopy and Related Surgery; October 2002, Vol 18/8, p. 845-853. Comments: This article shows that ACL reconstruction is well worthwhile in middle-aged people (defined as being over 40 years old). Allografting brings a satisfactory success rate here. Any over-40 person whose doctor still advises that ACL reconstruction be avoided merely because of age would do well to cite both this study and the November 2000 AJARS study by Noyes and Barber-Westin.

Arthroscopic Repair of Meniscus Tears Extending Into the Avascular Zone With or Without Anterior Cruciate Ligament Reconstruction in Patients 40 Years of Age and Older , Frank R. Noyes and Sue D. Barber-Westin; Arthroscopy, The Journal of Arthroscopy and Related Surgery; November 2000, Vol 16, p. 822–829. Comments: In this superbly insightful article, Noyes and Barber-Westin make it clear that ACL reconstruction and meniscal repair are both extremely worthwhile procedures in middle-aged (age 40 and older) patients. This article is a must-read for anyone in this age group who has a meniscal tear, a torn ACL, or both (especially if one's doctor is still trying to use the timeworn "old broad" argument that the patient is too old to benefit from an ACL reconstruction or meniscal repair). With regards to meniscal repair, the authors note that the typical approach to avascular (central third) zone tears is simply to cut out the torn portion, and they warn that such partial menisectomy results in the remainder of the meniscus being rendered essentially useless. In this study, meniscal repair brought excellent results for patients who underwent ACL reconstruction concurrently. The underlying message of this article is clear, and it applies to anyone (of any age) who has a meniscal tear to deal with: every effort should be made to preserve every ounce of meniscal tissue, even if it means time-consuming and painstaking work for the surgeon and a more protracted rehabilitation (i.e. period of non-weightbearing) for the patient afterwards. All this is good news for a middle-aged (40 or older) person with a torn ACL and meniscal damage: the success rate is good, and the long-term benefits are profound. Any age-related arguments advanced against these proven knee-restorative surgeries are now well past their expiry dates.

Reconstruction of the Anterior Cruciate Ligament in Patients Who Are at Least Forty Years Old. A Long-Term Follow-up and Outcome Study, Kevin D. Plancher et al.; Journal of Bone and Joint Surgery; February 1998, Vol 80, p. 184-197. Comments: This study shows that for mature people (defined herein as being 40 years or age or more), having a torn ACL reconstructed is definitely worthwhile. As with younger patients, it is important that the rehabilitation protocol be followed closely. The authors also note that returning to ACL-demanding sports with an ACL-deficient knee, even with a brace and strong leg musculature, will very likely result in repeated giving-way incidents and therefore more cumulative and permanent damage to articular and meniscal cartilage. And, as is also true for younger patients, the longer the knee has been ACL-deficient, the greater the likelihood of problems with ACL reconstruction. The reason for this is that if a knee is left ACL-deficient for extended periods of time, then the secondary restraints loosen, and so the entire knee becomes very loose (note that this is a problem even if the knee does not formally give out; this is so because an ACL deficient knee manifests an abnormal knee motion, instead of the normal tightly-controlled roll-and-glide motion). Such looseness translates into increased demands on the graft, and therefore greater chances of the graft stretching out. It is clear that anyone (regardless of age) who ruptures an ACL would be well-advised to not delay ACL reconstruction.

An Analysis of Anterior Cruciate Ligament Reconstruction in Middle-Aged Patients, Keith A. Heier et al.; American Journal of Sports Medicine; July/August 1997, Vol 25, p. 527-532. Comments: This article makes it clear that ACL reconstruction is well worthwhile in middle-aged people. Heier et al. found that these patients had results that were no less impressive than younger ACL-reconstruction patients.

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