An ACL tear is sometimes accompanied by a torn meniscus, the cartilage that helps cushion and stabilize the knee. When both injuries are present and the meniscus is suitable for repair, ACL reconstruction and meniscus repair may be performed during the same operation.
Treating both injuries together can help restore knee stability while preserving as much of the natural meniscus as possible. However, the exact surgical approach and rehabilitation plan depend on the type and location of the meniscus tear, the ACL injury, and other findings in the knee.
Why Do ACL Tears and Meniscus Tears Occur Together?
The ACL helps control forward movement and rotation of the knee. The menisci help distribute load, absorb shock, and contribute to knee stability.
A force strong enough to tear the ACL can also place substantial stress on the meniscus. As a result, meniscal tears are relatively common in people with ACL injuries.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
The meniscus may be torn at the same time as the ACL injury, or it may become damaged later if an ACL-deficient knee repeatedly gives way.
Why Is Meniscus Preservation Important?
Whenever a meniscus tear is repairable, preserving the meniscal tissue is generally preferred over removing the damaged portion when clinically appropriate.
The meniscus contributes to load distribution, shock absorption, joint stability, and protection of the knee cartilage. The American Academy of Orthopaedic Surgeons recommends considering meniscal preservation in patients with ACL and meniscus tears to help optimize joint health and function.
Not every meniscus tear can be repaired. The decision depends on factors such as the tear pattern, location, tissue quality, blood supply, stability of the tear, and whether the damaged tissue can be brought together securely.
What Happens During ACL Reconstruction With Meniscus Repair?
When both procedures are appropriate, they are commonly performed during the same arthroscopic operation.
1. Examination of the knee
The surgeon examines the knee using an arthroscope and assesses the ACL, menisci, cartilage, and other structures.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
2. Meniscus assessment
The meniscus tear is evaluated to determine whether it can be repaired. The repair technique depends on the tear's location and pattern.
3. Meniscus repair
If repair is appropriate, the torn meniscal tissue is repositioned and secured using sutures or another appropriate fixation technique. The goal is to preserve the meniscus and allow it to heal.
4. ACL reconstruction
The torn ACL is reconstructed using an appropriate graft. The graft is positioned within the knee and secured to restore the ligament's stabilizing function. The order and specific techniques used during surgery can vary according to the surgeon's approach and the individual injuries.
Does Meniscus Repair Change ACL Recovery?
It can. Rehabilitation after combined ACL reconstruction and meniscus repair may be more restricted than rehabilitation after an isolated ACL reconstruction, depending particularly on the type and location of the meniscus repair.
Your rehabilitation plan may include specific limits on knee movement, weight-bearing, bracing, or progression of exercises. These restrictions are not identical for every meniscus repair.
Recent evidence emphasizes that rehabilitation should be tailored to the characteristics of the meniscal tear and repair. More stable tear patterns may allow earlier progression, whereas complex, radial, or root tears may require greater protection during healing.
Will You Need Crutches After Surgery?
Crutches are commonly used during the early recovery period when weight-bearing needs to be limited or when walking is not yet comfortable. However, the duration varies considerably.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
The surgeon may prescribe partial or protected weight-bearing for a specific period depending on the meniscus tear, repair technique, ACL reconstruction, and overall stability of the knee.
There is no single weight-bearing schedule that applies to every combined ACL and meniscus procedure. Studies and clinical practice show substantial variation in postoperative rehabilitation protocols.
What Is Rehabilitation Like?
Rehabilitation has two major goals: allowing the repaired meniscus and reconstructed ACL to heal while progressively restoring normal knee function.
Early phase
- Controlling pain and swelling
- Restoring safe knee movement
- Activating the quadriceps
- Protecting the meniscus repair and ACL graft
- Using crutches or a brace when prescribed
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Strength and movement phase
As healing progresses, exercises are gradually increased to restore quadriceps and hamstring strength, balance, coordination, and control of the operated leg.
Functional rehabilitation
Later stages focus on activities that more closely resemble work, exercise, or sport. Running, jumping, cutting, and pivoting are introduced progressively when the knee has achieved appropriate strength, stability, movement quality, and healing.
When Can You Return to Sports?
Return to sport after combined ACL reconstruction and meniscus repair should not be based on a fixed date alone. The knee needs sufficient time for the ACL graft and repaired meniscus to heal, while strength, movement control, stability, and sport-specific function must also be restored.
Your rehabilitation team may use strength and functional testing to determine whether you are ready to progress. A return to high-demand pivoting sports should therefore be gradual and criteria-based rather than determined only by how the knee feels.
What Happens If the Meniscus Cannot Be Repaired?
Not every meniscus tear is repairable. Some tears have damaged or unstable tissue that cannot be successfully restored to a healing position.
When repair is not possible, the surgeon may need to remove only the damaged portion of the meniscus if it is causing symptoms or interfering with knee function. The appropriate approach depends on the specific tear and the condition of the remaining meniscal tissue.
When a repair is feasible, preserving the meniscus is generally preferred because maintaining meniscal tissue can be important for long-term joint health.
What Can Affect Recovery?
Recovery is influenced by more than the ACL graft itself. Important factors include:
- The type and location of the meniscus tear
- The method used to repair the meniscus
- The type of ACL graft and reconstruction technique
- Other cartilage or ligament injuries
- Preoperative knee stiffness or swelling
- Strength and movement before surgery
- Adherence to the rehabilitation program
- Individual healing and response to treatment
The Bottom Line
ACL reconstruction with meniscus repair addresses two important injuries in the same knee. When a meniscus tear is repairable, preserving the meniscus can help maintain its role in load distribution, stability, and long-term joint health.
The presence of a meniscus repair can also influence rehabilitation, particularly the progression of weight-bearing and knee movement. Recovery should therefore be individualized according to the tear pattern, repair technique, ACL reconstruction, and progress during rehabilitation.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
