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The menisci serve important functions in the normal knee. These functions include: assisting in load transfer, shock absorption, joint stability, and joint lubrication. Despite an increased awareness of these functions, and of the deleterious effects of meniscectomy, meniscectomy is often still necessary. Thus, the management of the painful, post-meniscectomy knee continues to challenge orthopaedic surgeons. Meniscal allograft transplantation was developed in an attempt to prevent the progressive deterioration that occurs following meniscectomy. Proper treatment requires an assessment of the patient's activity level, disability, associated injuries, and degree of arthrosis and deformity. Surgeons should be familiar with the various methods of allograft tissue banking and their potential effects on allograft function, disease transmission, and cost. Most current clinical reports of meniscal transplantation are limited to short-term evaluation of heterogeneous patient populations and techniques. As such, although meniscal transplantation remains a cautiously optimistic treatment for the future, at present it should be considered a salvage procedure in the treatment of the painful, early arthritic knee following meniscectomy.