Meniscal transplantation as a treatment of degenerative knee joint disease remains controversial. When confronted with a medial or lateral compartmental pain syndrome in a patient after total meniscectomy, the orthopedic surgeon faces manifest therapeutic challenges. Apparently, satisfactory results can be obtained consistently after proper correction of axial malalignment. However, in the well-aligned knee joint, it seems logical to reimplant the meniscus when it has been removed anteriorly and incapacitating pain has led to functional impairment. Experience gained from medium-term implantation results suggests that arthroscopically assisted lateral transplantation is the most effective procedure, whereas the open technique seems to be best suited for medial meniscal transplantation, with either dual or single skin incision allowing for medial collateral ligament release. The use of bone blocks for allograft fixation is still controversial because meniscal implantation should be anatomic to restore meniscal function. Accurate bone block fixation is difficult, but meniscal transplantation without bone blocks might induce erratic meniscal behavior.