Meniscal transplantation has become an accepted treatment option for selected symptomatic patients who have undergone a complete or near-complete meniscectomy. Basic and preliminary clinical studies suggest a meniscal allograft may replicate (though not completely) the shock-absorbing function of the normal meniscus to alleviate pain and provide measurable improvement in knee function. However, there is limited information on which to base crucial clinical decisions in treating the meniscectomized patient. I systematically explored available literature to address four general questions: Who is the ideal patient for a meniscal transplantation? What is the ideal method of graft sizing, preservation, and implantation? What is the accepted means of postoperative rehabilitation and timing of a return to athletic activities? And finally, what is the overall success rate of this procedure? This review of existing clinical trials revealed several crucial treatment principles for surgeons performing this procedure: (1) achieving or reestablishing normal knee alignment and stability; (2) implanting a size-matched, non-irradiated graft with secure fixation of the meniscal horns; and (3) ensuring patients return only to light sports activities to maximize the chances for graft survival. By following these principles, symptomatic improvement can be achieved in the majority of patients.