While the reasons for ACL reconstruction failure can be multifactorial, medial meniscus deficiency remains a major contributor. The posterior horn of the medial meniscus acts as an important secondary restraint to anterior tibial translation. Functional or subtotal meniscectomy increases forces on the ACL graft, leading to attritional graft laxity and symptomatic recurrent instability. Additionally, loss of medial meniscal tissue increases the contact pressures in the medial compartment and may contribute to the development of post-meniscectomy syndrome. This chapter presents a complex case involving a three-time ACL reconstruction failure in the setting of medial meniscus deficiency. The chapter highlights the decision-making process required to identify and treat risk factors that contributed to failure of previous ACL reconstruction. As will be demonstrated, the addition of medial MAT contributes to functional stability and reduces painful medial symptoms. Medial MAT is a useful adjunct to revision ACL reconstruction during salvage intervention.