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Multiple studies have shown both ACL\u2010deficient knees lead to increased risk of meniscal injury, as well as multiple types of meniscal tears or deficiency leading to increased risk of ACL tear or ACL reconstruction (ACLR) failures. All amenable meniscal tears, such as red\u2010red peripheral tears, radial tears, root tears, lateral meniscal oblique radial tears, and ramp lesions should be attempted to be repaired at time of ACLR. In addition, other contributors to rotational stability, such as collateral, posterolateral\/posteromedial corner, anterolateral injuries, and excessive posterior tibial slope should be identified and addressed. Rotational stability should be part of every ACL surgeon's algorithm; in my practice, my preference for patients who will place high rotational stress on their knee is for bone\u2010patellar tendon\u2010bone autograft ACLR, aggressively repairing aforementioned meniscal pathology, and adding anterolateral extraarticular reconstructions when recurvatum\/ligamentous laxity, increased posterior tibial slope, high\u2010risk patients (e.g., young female athletes in pivoting sports), or high\u2010grade pivot shift is present.<\/jats:p>","DOI":"10.1016\/j.arthro.2025.03.001","type":"journal-article","created":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T11:17:29Z","timestamp":1741346249000},"page":"2955-2957","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":4,"title":["<i>Editorial Commentary<\/i>\n                    : Anterior Cruciate Ligament Reconstruction Success Requires Additional Correction of Tibial Slope, Rotational Instability, and Meniscus Pathology: Meniscal Repair Failure Increases Knee Rotational Laxity"],"prefix":"10.1002","volume":"41","author":[{"given":"Andrew S.","family":"Bi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Chahla","sequence":"additional","affiliation":[{"name":"Rush University Medical 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proposed mechanism of high\u2010grade pivot shift","volume":"11","author":"Kim Y.S.","year":"2023","journal-title":"Orthop J Sports Med"},{"key":"e_1_2_3_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465221102135"},{"key":"e_1_2_3_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2022.11.001"},{"key":"e_1_2_3_13_1","unstructured":"J.T.Childers B.T.Lack C.C.Mowers et al.Substantial variability exists in reporting clinically significant outcome measure thresholds for arthroscopic anterior cruciate ligament reconstruction: A systematic review.Arthroscopypublished online January 30 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