I am a 43 year old Athlete and I tore my ACL, now what?

The short answer is, you don't need it.  As a sports medicine surgeon, I live to get people "back in the game", be that Eathampton HS football or the over 40 soccer leage at Allsports.  However, most of life does not require an ACL.  So why can I ski bumps without an ACL, but my kid's babysitter should have it reconstructed?  The answer lies with age.  In the over 40 population, it has long been thought that there are 3 groups of people who tear their ACLs: Copers, Adapters, and non-Copers.

If you are a Coper, with some dedicated rehab and a brace, you can return to all of the dumb things you were doing before you tore your ACL.  If you are an Adapter, with some good rehab and a whiff of mortality, you get back to life and many of the things you were doing before, but you take a less aggressive approach to athletics.  You limit the cutting, twisting, pivoting sports, but can remain active in athletics that are less "ACL Dependant".  If you are a non-Coper, you knee feels unstable inspite of dedicated rehab and a brace, and you are unwilling to accept the limitations that this injury has foisted on you.  In this case, there is decent evidence that an ACL reconstruction will help you stabilize your knee and get you "Back in the Game".  For most middle aged athletes, life is busy and they don't have the time to jump right into the 6-9 month rehab that an ACL recontruction requires, so the most common recommendation is to try non-surgical management of the ACL tear and see how it goes.