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.

Aims: Patellar instability and painful patellar mal-tracking are common challenging conditions faced by a knee surgeon. Our purpose was to describe an arthroscopy assisted method of medial patellofemoral ligament reconstruction to address these conditions present our results using this modified technique.

Materials & Method: Between April 2001 and December 2003, 22 knees in 20 consecutive patients underwent arthroscopically assisted MPFL reconstruction using an autologous hamstring tendon. There were 12 female and 8 male patients passed with a mean age of 29.9 years. The knees were assessed using Fulkerson’s and Kujala’s scoring systems and the mean follow-up period was 20.8 months (range 12–35).

The technique uses a single hamstring tendon with undisturbed biological distal attachment, where the free end is routed through a longitudinal tunnel in the dorso-medial aspect of the patella and fixed to an isometric point near the medial femoral epicondyle using an interference screw. The position of femoral attachment is the most important factor in achieving an isometric graft.

Results: There was a significant increase (p=< 0.0001) in mean Fulkerson score of 35.4 from a pre-operative value of 47.4 to a post-operative value of 82.9. Sixteen patients rated their knees as good or excellent and there was only one complication of complex regional pain syndrome. 11 of 13 patients who were keen on sports returned to their sports at a mean of 3.9 months (range 1–10).

Conclusion: We report good results with this technique of medial patello femoral ligament reconstruction and would advocate it as an effective surgical option for patients with recurrent lateral instability as well as those with painful lateral mal-tracking.