Modern Treatment Strategies for Meniscal Injuries: A Narrative Review of Biological and Mechanical Approaches

Background Meniscal injuries are common knee pathologies that can impair joint biomechanics and increase the risk of osteoarthritis. Advances in meniscal preservation have expanded treatment options, but optimal management remains challenging because outcomes depend on tear characteristics, vascularity, patient factors, and concomitant injuries. Aim This narrative review summarizes current mechanical and biological treatment strategies for meniscal injuries, with emphasis on their indications, limitations, clinical applications, and emerging regenerative approaches, as well as the role of individualized treatment selection in preserving meniscal tissue and optimizing long term knee joint function. Materials and Methods A structured search of PubMed and Google Scholar was performed for English language publications from January 2016 to August 2026, with earlier landmark studies included when relevant. A total of 44 publications were included in the narrative synthesis. Results Current evidence favors meniscal preservation over resection whenever feasible. Meniscal repair provides favorable long-term outcomes, while platelet-rich plasma (PRP) has the strongest clinical evidence among biological augmentation strategies. Meniscal allograft transplantation may improve function in selected patients with meniscal deficiency. Cell-based therapies, biostimulation, synthetic implants, and tissue-engineered scaffolds show promise but require further clinical validation. Conclusion Meniscal preservation should remain the primary therapeutic goal whenever feasible. Treatment should be individualized according to patient and tear characteristics. Further high-quality studies are needed to establish the long-term efficacy of emerging biological and regenerative strategies and their role in preventing osteoarthritis.