Return to sport after meniscectomy, meniscal repair, and meniscal allograft transplantation for meniscal lesions in athletes: A systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to quantify and compare the evidence on the results obtained with the surgical treatments for meniscal lesions in athletes. A literature search was conducted on PubMed, Cochrane and Web of Science in August 2025 according to the PRISMA guidelines. Inclusion criteria were clinical studies (randomised controlled trials [RCTs], non-randomised comparative studies and case series), &#x2265;6 patients, in the English language, on the surgical treatment of meniscal lesions in athletes. A meta-analysis was conducted on the rate of patients returning to sport, the time to return to sport, and the rate of patients returning to the pre-injury level of sport. Patient-reported outcome measures, adverse events, failures and reoperation rates, as well as risk of bias and quality of evidence, were also documented. The risk of bias was assessed using the Cochrane RoB 2.0 tool, the Cochrane ROBINS-I tool, and the JBI Critical appraisal checklist. The quality of evidence was assessed using a modified Coleman score and the GRADE tool. The mean time to return to sport was 2.1 months for meniscectomy, 5.8 months for meniscal repair, and 8.9 months for meniscal allograft transplantation (MAT). Statistically significant differences were observed between meniscectomy and repair and between meniscectomy and MAT (both p&#x2009;<&#x2009;0.001). Meniscectomy showed a return to sport rate of 98.2%, meniscal repair of 96.9%, and MAT of 94.2%, while return to the same pre-injury level of sport was reported as 84.4% for meniscectomy, 81.3% for meniscal repair, and 77.4% for MAT, with no statistically significant differences between groups. The mean modified Coleman Methodology Score for the included studies was 66.6&#x2009;&#xb1;&#x2009;7.0. Meniscectomy, meniscal repair, and MAT are all able to provide high rates of return to sport in athletes. In the investigated treatment cohorts, meniscectomy presented the shortest pooled time to return to sport, followed by meniscal repair and MAT. Importantly, all treatments offered good rates of return to the same level of athletic performance. The treatment choice should be guided by an individualised, multidisciplinary approach aimed at providing a patient-tailored treatment strategy to optimise both athletic recovery and joint preservation. Level I.