The development of premature osteoarthritis after anterior cruciate ligament (ACL) reconstruction is a significant cause of morbidity in young, active individuals. Meniscal injuries are frequently noted at the time of reconstruction, and the critical role of an intact meniscus in the prevention of osteoarthritis has been well documented. The purpose of this review is to evaluate the effects of meniscal status at ACL reconstruction on the subsequent development of osteoarthritis. A systematic review of the literature identified 11 studies with > or = 2 years of follow-up that compared patients' radiographic outcomes based on meniscus status at the time of ACL reconstruction. Patients undergoing partial meniscectomy at the time of ACL reconstruction were significantly more likely to develop radiographic evidence of osteoarthritis than those with normal menisci. Meniscal repair resulted in inconsistent findings. Virtually all patients who underwent complete meniscectomy at the time of ACL reconstruction had radiographic evidence of osteoarthritis at follow-up.