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Failed ACL Reconstruction and Meniscus Deficiency: Background, Indications, and Techniques for Revision ACL Reconstruction With Allograft Meniscus Transplantation

In the proper setting, a single stage meniscus transplantation and revision ACL results in a therapeutic synergy. The stability from the revision ACL reconstruction protects the meniscus transplant, and the meniscus transplant provides a secondary restraint to protect the revised ACL reconstruction. This is particularly true in the case of the posterior horn of the medial meniscus. With proper patient selection, thorough preoperative planning, and meticulous attention to technique, this combined treatment can provide an optimal outcome to the patient with a failed ACL reconstruction and a deficient meniscus. This article discusses the indications, patient evaluation, and technical considerations combining these 2 procedures, particularly with respect to tibial tunnel placement.