He had a chronic ACL deficiency which was symptomatic and prohibited him from leading an active and sporty life. He loved to participate in road races, hike, trek, and climb. Clearly an ACL deficient knee did not stand up to the rigours of outdoor sports and further damage was likely to ensue. Even middle aged persons with a symptomatic knee can benefit from ACL reconstruction. This was done arthroscopically using a patellar tendon bone block. After two weeks, he underwent arthroscopic sugery for a partial thickness rotator cuff tear.