Purpose: Anterior Cruciate Ligament (ACL) deficiency can result in symptomatic instability of the knee resulting in subsequent functional instability regardless of the patient’s age.

We reviewed a single surgeon database of 908 ACL reconstructions (ACLR’s) carried out in the last 20 years. 14 patients were identified who were 55 years or over at the time of ACLR (mean age: 60 years, range: 55–75 years). Patients were evaluated clinically and with clinical outcome scoring and KT-1000 arthrometry assessment. One patient had died but the other 13 patients were available to attend for follow-up at an average of 9.7 years post-ACLR. One patient had undergone total knee replacement. For the remainder: the most recent mean Lysholm score was 76 - improving from 35 pre-ACLR (p< 0.05); KT-1000 testing at 30 degrees flexion with 30lbs force demonstrated a side-to-side difference > 2mm in only one knee; only the same knee demonstrated a pivot shift. The most recent mean Tegner score was 3.10.

Conclusion: Anterior cruciate ligament reconstruction with autograft in the over-55 patient with minimal arthrosis is a safe procedure that returns stability to the knee and allows for return to a reasonable level of activity over the medium to long-term in the majority of cases.