PurposeThe purpose of this study was to investigate the relationship between tunnel position in ACL reconstruction (ACL-R) and postoperative meniscus tears.MethodsThis was a single institution, case–control study of 170 patients status-post ACL-R (2010–2019) separated into two matched groups (sex, age, BMI, graft type). Group 1—symptomatic, operative meniscus tears (both de novo and recurrent) after ACL-R. Group 2—no postoperative meniscus tears. Femoral and tibial tunnel positions were measured by 2 authors via lateral knee radiographs that were used to measure two ratios (a/t and b/h). Ratio a/t was defined as distance from the tunnel center to dorsal most subchondral contour of the lateral femoral condyle (a) divided by total sagittal diameter of the lateral condyle along Blumensaat’s line (t). The ratio b/h was defined as distance between the tunnel and Blumensaat’s line (b) divided by maximum intercondylar notch height (h). Wilcoxon sign-ranks paired test was used to compare measurements between groups (alpha set atp< 0.05).ResultsGroup 1 had average follow up of 45 months and Group 2 had average follow up of 22 months. There were no significant demographic differences between Groups 1 and 2. Group 1—a/t was 32.0% (± 10.2), which was significantly more anterior than group 2, 29.3% (± 7.3;p< 0.05). There was no difference in average femoral tunnel ratio b/h or tibial tunnel placement between groups.ConclusionsA relationship exists between more anterior/less anatomic femoral tunnel position and the presence of recurrent or de novo, operative meniscus tears after ACL-R. Surgeons performing ACL-R should strive for recreation of native anatomy via proper tunnel placement to maximize postoperative outcomes.Level of evidenceLevel III.