Meniscal preservation during anterior cruciate ligament (ACL) reconstruction may play a critical role in improving long-term knee outcomes when concurrent meniscal tears are present. Evidence suggests that repairing the meniscus—rather than performing partial meniscectomy—helps maintain native load distribution and joint stability, which are essential for protecting cartilage and preserving knee biomechanics. Patients undergoing meniscal repair alongside ACL reconstruction demonstrated improved joint preservation and potentially lower risks of degenerative changes compared with those who underwent meniscectomy. These findings reinforce the growing emphasis on meniscal-saving strategies in ligament surgery, highlighting the importance of preserving meniscal tissue whenever feasible to optimize functional recovery and long-term joint health.