Editorial Commentary: Fourteen-Year Follow-Up Shows High Overall Incidence of Osteoarthritis With Anatomic Single-Bundle and Double-Bundle Anterior Cruciate Ligament Reconstruction: Perform an Anatomic Reconstruction but Also Save the Meniscus!

Literature over the past decades has evaluated the biomechanical and functional difference between anatomic single-bundle and double-bundle anterior cruciate ligament reconstructions (ACLRs). Meniscus tears, particularly medial meniscus ramp lesions or lateral meniscus root tears, are often identified during ACLRs and can lead to knee instability and accelerated arthritic changes if missed or not treated. Equivalent patient-reported clinical outcomes have been reported between single-bundle and double-bundle ACLRs; however, many of these studies were performed when meniscectomy was the predominant treatment for meniscal injury and likely has impacted the high rates of post-traumatic osteoarthritis reported after ACLR. Further energy should be placed into identifying the long-term outcomes of anatomic ACLRs with concomitant meniscus repair to see if we can improve the rates of post-traumatic osteoarthritis.