Although anterior cruciate ligament (ACL) injury usually occurs without a high energy pivot mechanism, the energy of trauma is absorbed by the structures such as menisci or cartilage in the knee and in some cases damage may occur in these structures. Meniscus injuries are generally evaluated carefully by orthopaedic surgeons, however especially occult injuries in cartilage can be missed in imaging and arthroscopic examination. Cartilage injuries that are not treated properly may cause as much as pain as the meniscus tears postoperatively and negatively affect rehabilitation and return to sports. In this review, attention is drawn to how to approach cartilage damage in ACL injury and how it can affect the success of treatment.