An Acta Orthopaedica educational article: Current strategies for meniscal preservation in anterior cruciate ligament reconstruction.

Meniscal preservation is a cornerstone of anterior cruciate ligament reconstruction (ACLR), reflecting the meniscus' critical role in joint homeostasis and long-term knee health. Concomitant meniscal injuries are common and increasingly managed with repair rather than resection. This educational review summarizes current strategies for the most frequent acute meniscal tears encountered during ACLR. Contemporary practice favors repair whenever feasible, supported by evidence linking meniscal preservation to improved outcomes and reduced osteoarthritis risk. Lateral meniscus posterior root tears are commonly managed with transtibial or anchor-based repair. Ramp lesions require systematic inspection and selective repair, with both all-inside and suture-based techniques yielding favorable results. Bucket-handle tears are repaired using all-inside, inside-out, or combined approaches depending on tear location, with high survival rates when performed alongside ACLR. Radial tears, particularly in vascular zones, should be repaired to restore hoop stress, although optimal suture configurations remain debated. Successful outcomes rely on mechanically stable repairs, individualized rehabilitation, knee stability and alignment, and a supportive biological environment.