Purpose of Review <p>Similar to primary anterior cruciate ligament reconstruction (ACLR), meniscal pathology is frequently encountered during revision ACLR (RACLR). In the revision setting, however, meniscal disease often presents a greater challenge because tissue quality may be compromised, particularly when prior meniscal treatment was performed at the index ACLR. This review highlights key considerations and treatment strategies for managing extensive, complex meniscal lesions in the setting of RACLR.</p> Recent Findings <p>Graft failure significantly increases the incidence of meniscal tears. Furthermore, graft insufficiency may result in extensive, complex, and sometimes, irreparable meniscal tears. Meniscal treatment strategies, and ultimately joint preservation, have been studied to restore appropriate knee anatomy and biomechanics. Furthermore, special considerations must be made to best treat a wide range of meniscal pathologies in the RACLR, especially in a suboptimal joint environment.</p> Summary <p>Graft failure requiring revision ACL reconstruction is often accompanied by extensive, complex meniscal tearing. Meniscus-preserving strategies may help restore knee anatomy and biomechanics and, in turn, may slow the progression of osteoarthritis.</p>