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Introduction: The treatment of an ACL lesion in patients who are above 40 years of age remains controversial. The aim of this study is to report the subjective impression of the result after ACL reconstruction in 24 such patients., Material and Methods: The records of 24 patients, who were aged 40 or older when they had ACL reconstruction were reviewed. The average age was 43 years (40-49), 10 women and 14 men. The mean interval between injury and operation was 35 months (6-185). All 24 patients completed a self-administered questionnaire to evaluate A) preoperative status, B) the rehabilitation period, and C) postoperative status and their overall view of the treatment. Status was made 16 months postoperatively (5-41)., Results: Preoperatively, 23 out of 24 patients had instability problems in daily living (ADL) and at work. One had not experienced the knee giving way. All the patients had experienced pain. Postoperatively, 21 out of the 24 experienced no instability and 14 are free of pain. Eighteen have increased activity, five have no change in activity, and one has decreased activity. Sixteen are satisfied with the level of postoperative activity. Twenty-two find their knee status better postoperatively than preoperatively. One finds it unchanged, and one finds it worse. Overall 15 patients find result very satisfying, seven find it satisfying, and two find it poor. Twenty-two would advise others in a similar situation to have the operation done, whereas one is in doubt and one would not recommend the operation., Discussion: We conclude that the results of ACL reconstruction in patients above the age of 40 are as good as those in younger patients.

Seventeen patients with rupture of the anterior cruciate ligament and chronic instability were treated with the Leeds-Keio Dacron ligament system. The post-operative treatment included 15 weeks of immobilisation (five weeks with fixed knee, five weeks with 30-80 degrees of flexion and five weeks with 0-90 degrees of flexion). Muscular exercise were started after 5 weeks. They were submitted to clinical examination approximately 30 months (13-50) after implantation. The Lysholm-scoring was: excellent-good: 70%, fair: 6%, poor: 24%. These rather disappointing results could be explained by the regime: poor muscular strength and rehabilitation, long preoperative observation period and long post-operative immobilisation. We found a high frequency of rupture of the Leeds-Keio ligament system (18%) and fear, with reference to the literature, that it might increase with time. Rupture and loss of tension result in loss of stability and reactive synovitis. Though the material is small, we conclude that this regime can not be recommended.