Meniscal Allograft Transplantation in Athletes Offers Improved Function, Pain, and Satisfaction With High Levels of Return to Sport and Graft Survivorship Despite High Complication and Revision Rates: A Systematic Review.

PURPOSE: To assess graft survivorship, patient-reported outcomes, return-to-sport rates, and complications after meniscal allograft transplantation in athletic populations. METHODS: A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. PubMed, Scopus, and Embase were searched from database inception through March 2026. Studies were included if they reported outcomes of meniscal allograft transplantation in athletic patients aged ≥18 years with a minimum follow-up of 24 months and reported at least one of the following outcomes: graft survivorship or failure, patient-reported outcome measures, return to sport, complications, or revision procedures. Exclusion criteria included patients younger than 18 years, nonathletic populations, cadaveric, animal, or biomechanical studies, case reports, conference abstracts, editorials or review articles, studies not published in English, and studies not specifically evaluating meniscal allograft transplantation outcomes in athletes. Data were synthesized qualitatively because of heterogeneity across studies. Study quality was assessed using the Methodological Index for Non-Randomized Studies. RESULTS: Thirteen studies including 1021 patients (mean age range 19.3-45.3 years; mean follow-up 24-129.6 months) met inclusion criteria. Patient-reported outcome measures improved across studies, including increases in Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee, and Lysholm scores and reductions in visual analog scale pain compared with preoperative values. Overall return to sport was achieved in 752 of 928 athletes (81.0%), with return to sport occurring at a mean of 7.3 to 15.8 months. Return to the same or higher level of sport was achieved in 141 of 225 athletes (62.7%). Graft survivorship ranged from 78% to 95% at 2 years and declined to approximately 70% at 12 years. A total of 134 revision procedures (13.1%) and 255 postoperative complications (25.0%) were reported. The most commonly reported complications were joint stiffness 43 (4.2%), swelling 30 (2.9%), mechanical symptoms such as catching or locking 29 (2.8%), pain 25 (2.4%), and graft tear or extrusion 21 (2.1%). CONCLUSIONS: Meniscal allograft transplantation in athletic populations delivers substantial and sustained improvements in pain, function, and satisfaction, with over 80% of athletes returning to sport, whereas graft survivorship decreases from approximately 90% at 2 years to 70% by 12 years. However, nearly 1 in 4 patients will require revision or experience complications. LEVEL OF EVIDENCE: Level IV, systematic review of Level III and IV studies.