Clinical and arthroscopic outcomes of hamstring autograft ACL reconstruction in patients aged 60 Years and older compared with middle-aged patients

Background: Although Anterior cruciate ligament reconstruction (ACLR) in elderly patients has traditionally been avoided, the clinical demand for ACLR in individuals aged ≥60 years is growing recently. Nevertheless, few studies have directly compared outcomes of ACLR between elderly and middle-aged patients, especially using second-look arthroscopy. Furthermore, prior comparative studies have focused on allograft or bone-patellar tendon-bone grafts; evidence specific to hamstring autograft ACLR remains limited. Objectives: To compare clinical and arthroscopic outcomes of hamstring autograft ACLR in patients aged ≥60 years versus 40-59 years. Methods: In this retrospective cohort, 56 patients aged ≥40 years underwent primary hamstring autograft ACLR between 2018 and 2024. Patients were grouped as middle-aged (40-59 years, n = 34) or older (≥60 years, n = 22). Outcomes included Lysholm score, Tegner activity score, anterior tibial translation, and arthroscopic cartilage status. Results: There were no significant differences in Lysholm score at 1 year postoperatively (82.1 ± 14.4 vs. 83.4 ± 10.9; p = 0.721) or in ΔLysholm score (27.6 ± 19.0 vs. 28.6 ± 22.7; p = 0.865) between middle-aged and older groups. Postoperative Tegner activity score also did not differ between groups (4.00 [1.00-7.00] vs. 3.00 [2.00-5.00]; p = 0.156). Second-look arthroscopic evaluations revealed no significant group differences in cartilage degeneration across all compartments. No complications or graft failures were observed in either group. Conclusion: Patients aged ≥60 years demonstrated comparable clinical and arthroscopic outcomes to those of middle-aged patients following hamstring autograft ACLR. With appropriate patient selection, advanced age alone should not limit the indication for ACLR.