Anterior cruciate ligament reconstruction (ACLR) is a well-established procedure utilized in the setting of ACL injuries in patients under age 40. The management of ACL injuries in older populations is controversial as best practices are not clear with regard to candidacy for surgery, graft choice, fixation, and rehabilitation. In this review, we will examine the body of literature surrounding controversies in management of ACL tears in older patients. Of note, “aging athlete” has a fluid definition throughout this review as the literature describes patients as young as 30 as in the “aging” category.