Abstract Background Prior evidence comparing meniscal allograft transplantation (MAT) and meniscal scaffold implantation (MSI) is limited by variable follow-up, with patient-reported-outcome-measures (PROMs) pooled across disparate time points. We addressed this with time-stratified outcome pooling. Methods We searched MEDLINE, Embase, and Web of Science Core Collection to 25 April 2025; PROSPERO registration CRD42024536408. Adults undergoing MAT or MSI (≥10 participants; 2-year follow-up) were eligible. Random-effects meta-analyses pooled PROMs at 0–2, 2–5, and 5 years; survival, return-to-sport (RTS), and complications were summarised descriptively. Risk of bias was assessed using Modified Coleman Methodology Score (MCMS). Results Eighty-one studies (MAT 59, n = 4292; MSI 22, n = 1009) were included. Overall study quality was fair-to-poor (MCMS 58.8 ± 11.1). PROMs improved after both. MAT maintained gains beyond five years (IKDC 73.1 at 2–5 years; 71.1 5 years), whereas MSI peaked at 2–5 years then declined (IKDC 72.5; 67.6 5 years); Tegner scores mirrored this pattern. Heterogeneity was considerable (27/29 analyses I² 50% and 24/29 I² 75%). Failure proportions were similar (MAT 18.6%; MSI 19.6%), but time to failure was longer after MAT (5.9 versus 3.1 years). Survival at fixed time points was comparable (∼90% at 5 years; ∼77% at 10 years). RTS was similar (∼65% return by 1 year; ∼50% to pre-injury level). Complications differed; further intervention was more commonly undertaken post-MAT. Conclusions Accounting for follow-up duration, MAT sustains functional gains beyond five years and shows greater durability than MSI. Prospective comparative studies with standardised failure definitions are needed to refine patient selection and expectations.
Singh et al. (2026) studied this question.