Data Backs ACL Reconstruction Over 50 in Athletic Patients

Anterior cruciate ligament (ACL) reconstruction may be an appropriate option for athletic patients over the age of 50, according to a new study presented at the 2026 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

Led by NYU Langone Orthopedics researchers, the study showed that most patients aged 50 years and older who underwent ACL reconstruction reported being satisfied with their surgery. They also had a low conversion rate to total knee arthroplasty (TKA) and a graft failure rate of 7.1 percent.

“Our study was prompted by a clear demographic shift,” says senior author Kirk A. Campbell, MD, an associate professor of orthopedic surgery. “More patients over the age of 50 are participating in sporting activities where an intact ACL is crucial.”

Dr. Campell explains that some surgeons are still reluctant to perform ACL reconstruction in athletic patients over the age of 50, often excluding patients based on their chronological age, not taking into account other relevant factors.

“Our findings support thoughtful, personalized decision making while reassuring both surgeons and patients that chronological age alone shouldn’t be a barrier to ACL reconstruction,” Dr. Campbell says.

High Satisfaction and Low Failure Rates

Within the NYU Langone system, the researchers performed a retrospective chart review of patients over the age of 50 who underwent primary ACL reconstruction between 2011 and 2023, analyzing their outcomes and failure rates.

The analysis included 155 patients, most of whom had received bone tendon bone and tibialis anterior allografts. With respect to outcomes, graft failure occurred in 7.1 percent of patients, meniscal repair failure in 20.6 percent with meniscal root repair, and 2.6 percent proceeded to TKA.

Most patients —83.9 percent—rated their outcome as ‘very good or excellent,’ with the vast majority—91.5 percent—reporting that surgery met their expectations. Overall, 88.2 percent achieved an acceptable symptom state. The researchers did not identify any significant predictors of outcome or failure.

“For well-selected patients over 50, ACL reconstruction can reliably restore knee stability, facilitate a return to meaningful activity, and deliver high satisfaction with low failure rates,” Dr. Campbell says.

Age is Just a Number

According to Dr. Campbell, several factors should be taken into consideration when assessing whether surgical intervention is appropriate for ACL injuries. Such factors include physiologic age, overall health, as well as functional and athletic goals.

“Surgical intervention for ACL injuries should not be ruled out on the basis of chronological age alone,” Dr. Campbell explains.

“We hope surgeons will counsel patients using data rather than assumptions, especially when patients’ activity level and overall quality of life are at stake.”