ACL Tear with Meniscus Damage

The ACL and the menisci work as a team to stabilize the knee. The ACL prevents the shinbone from sliding forward under the thighbone, while the menisci act as shock absorbers and stabilizers that distribute load across the joint. When a sudden pivoting, cutting, or landing movement ruptures the ACL, the resulting abnormal knee motion frequently damages the meniscus at the same time.

The pattern of meniscus injury can vary. Some patients sustain a small peripheral tear that may heal well with repair, while others suffer a large bucket-handle tear that displaces into the joint and causes mechanical locking. The location (medial vs. lateral meniscus) and the type of tear both influence treatment decisions significantly.

A 2025 study in the American Journal of Sports Medicine examining over 700 patients found that meniscal injuries were observed in more than 53% of patients who also had a medial collateral ligament injury alongside their ACL tear, compared with roughly 41% of patients with an isolated ACL injury. The presence of additional ligament damage further increases the risk of meniscal involvement, underscoring the importance of a thorough evaluation of the entire knee at the time of diagnosis.

When both the ACL and meniscus are damaged, the treatment strategy must account for both structures. Ignoring or inadequately treating either injury can lead to compounding problems:

• Accelerated osteoarthritis: Extensive research has demonstrated that ACL reconstruction combined with meniscectomy (removal of the damaged meniscus) accelerates the development of knee osteoarthritis. Preserving and repairing the meniscus during ACL reconstruction is now considered a priority for long-term joint protection.
• Increased re-injury risk: An ACL-deficient knee places more stress on the meniscus, and a meniscus-deficient knee places more stress on an ACL graft. Addressing both structures restores the knee’s natural biomechanical balance.
• Better surgical outcomes with single-stage surgery: A 2025 study published in the Journal of Experimental Orthopaedics found that patients who underwent single-stage ACL reconstruction with meniscus repair had significantly lower meniscus repair failure rates (15%) compared with those who had a two-stage procedure (35.9%). This strongly supports addressing both injuries in one operation when possible.

ACL Reconstruction with Meniscus Repair

This is the gold standard for most patients with a combined injury. During a single arthroscopic procedure, the torn ACL is reconstructed with a graft (autograft or allograft) and the meniscus tear is repaired using specialized suture techniques. Key considerations include:

• Graft selection: Patel discusses the advantages of patellar tendon, hamstring tendon, quadriceps tendon autograft, and allograft options based on each patient’s age, activity level, and anatomy.
• Meniscus repair technique: All-inside, inside-out, and outside-in repair techniques are available depending on the tear location and pattern. Patel ALWAYS has all options available at the time of surgery in order to do what is right for you. The goal is always to preserve as much meniscus tissue as possible.
• Meniscus repair outcomes: A 2024 study of professional athletes in the AJSM found an overall meniscus repair failure rate of 13.2% at long-term follow-up (mean 96 months), with lateral meniscus repairs performing better (5% failure) than medial meniscus repairs (15.4%).

ACL Repair with BEAR Implant

For eligible patients with acute ACL tears (within 50 days of injury) and an intact tibial stump, the Bridge-Enhanced ACL Restoration (BEAR) procedure may be an option. The BEAR implant is an FDA-approved collagen scaffold that is saturated with the patient’s own blood and placed between the torn ACL ends to facilitate natural healing. A 2025 review in Current Reviews in Musculoskeletal Medicine reported that across all three BEAR clinical trials, there was an aggregate re-tear rate of 15%, with post-market data showing non-inferior short-term outcomes compared to traditional reconstruction. Two-year results from the Bridge Registry presented at AOSSM 2025 showed a retear rate of just 5% among the first 100 patients.

However, the BEAR procedure does have specific indications and may not be appropriate for all patients, particularly high-level competitive athletes or those with certain tear patterns. Dr. Patel can help determine if you are a candidate.

ACL Reconstruction with Partial Meniscectomy

In cases where the meniscus tear is not repairable — such as highly degenerative tears, certain flap tears, or complex tears in the avascular zone — a partial meniscectomy (removal of only the damaged portion) may be performed alongside ACL reconstruction. While this relieves symptoms quickly, removing meniscus tissue does increase the long-term risk of osteoarthritis, which is why repair is always preferred when feasible.

Recovery from combined ACL reconstruction and meniscus repair requires a carefully structured rehabilitation program. The meniscus repair component typically adds some restrictions to the early phases of recovery:

• Weeks 0–6: Protected weight-bearing with crutches and a hinged knee brace. Range of motion is gradually progressed, typically reaching 90 degrees of flexion by week six. Deep squatting and twisting are avoided to protect the healing meniscus.
• Weeks 6–12: Progressive strengthening of the quadriceps, hamstrings, and hip musculature. Stationary cycling, swimming, and proprioceptive training are introduced.
• Months 3–6: Sport-specific exercises begin. Criteria-based progression is emphasized — patients advance based on strength, balance, and functional testing rather than time alone.
• Months 6–9+: Return-to-sport testing and gradual return to full activity. Studies show that combined ACL-meniscus surgery may extend return-to-sport timelines slightly compared to isolated ACL reconstruction, particularly when a medial meniscus repair is performed.

The 2024 EU-US Meniscus Rehabilitation Consensus (an ESSKA-AOSSM-AASPT initiative involving 67 experts from 14 countries) recommended that return to sport after meniscus surgery should be both criterion-based and time-based, incorporating patient-reported outcomes and performance measures to guide decisions.

Dr. Patel is a double board-certified, fellowship-trained orthopaedic surgeon with specialized expertise in complex knee disorders. His approach to combined ACL and meniscus injuries emphasizes:

• Meniscus preservation as a primary treatment philosophy
• Individualized graft selection based on your unique anatomy and goals
• Evidence-based surgical techniques informed by the latest research
• Comprehensive rehabilitation protocols developed in collaboration with experienced physical therapists

With offices in Downers Grove, Hinsdale, Westmont, Elmhurst, Western Springs, and Munster, Indiana, Dr. Patel serves patients throughout the Chicagoland area.