Purpose of Review <p>Meniscal preservation through repair and transplantation is fundamental to modern orthopaedic surgery, with the goal of restoring knee biomechanics and delaying degenerative joint disease. Despite generally favorable outcomes, these procedures are associated with a range of complications and reoperations. This review aims to comprehensively evaluate the current literature on complications and reoperations following meniscal repair and meniscal transplantation, with emphasis on failure mechanisms, risk factors, and management strategies.</p> Recent Findings <p>Recent literature reports wide variability in complication and reoperation rates following meniscal repair and transplantation, reflecting heterogeneity in tear morphology, surgical techniques, patient selection, and definitions of failure. Common complications include persistent pain, recurrent mechanical symptoms, repair failure, chondral injury, stiffness, infection, and neurovascular injury. Meniscal transplantation is associated with distinct risks and failure modes, including graft extrusion, sizing mismatch, immunologic response, and progression of osteoarthritis. Advances in repair devices, root repair techniques, and biologic augmentation have improved clinical outcomes but have not eliminated procedure-related complications. Increasing attention has been placed on patient-specific factors such as age, activity level, limb alignment, and concomitant pathology.</p> Summary <p>Complications and reoperations following meniscal repair and transplantation remain clinically relevant and multifactorial. Optimizing outcomes requires appropriate patient selection, meticulous surgical technique, and recognition of procedure-specific risk profiles. Standardization of outcome measures and failure definitions is necessary to improve study comparability. Future research should focus on long-term outcomes, biologic optimization, and strategies to reduce reoperation rates while preserving meniscal function</p>