Q: I tore my anterior cruciate ligament doing something as simple as gardening. The doctor thought it was probably ready to go and almost anything could have caused the rupture. I'm older so I've put off having surgery to repair it. Is that a mistake -- does it even matter exactly when the surgery is done?

A: Older age can make a difference in outcomes after anterior cruciate ligament (ACL) repair or reconstruction. Graft rupture, increased stiffness, and decreased activity level are reported more often in older groups. But it's not always clear whether this is a result of age following ACL surgery or a natural response to aging.

Many people decrease their participation in sports and recreational activities as they get older. For those who remain active, the frequency, level of intensity, and endurance (duration engaged in the activity) declines over time.

Some studies have shown that waiting more than five months between injury and repair can have a negative effect on results. But whether older age contributes to this result is not always clear.

Most surgeons recommend conservative (nonoperative) care at first for patients who aren't athletes and who don't plan on running marathons. With strength training, the muscles around the knee can support and stabilize the joint in the absence of an intact ACL.

Your surgeon is really the best one to advise you on an optimal management plan. Age, activity level, general health, strength, and your personal goals are all taken into consideration when planning your surgery and the timing of that procedure.

Reference: Björn Barenius, MD, et al. Quality of Life and Clinical Outcome After Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Graft or Quadrupled Semitendinosus Graft. In The American Journal of Sports Medicine. August 2010. Vol. 38. No. 8. Pp. 1533-1541.