Purpose of Review <p>Meniscal preservation is a cornerstone of modern knee surgery given the meniscus’s essential role in load transmission, joint stability, and cartilage protection. As indications for meniscal repair have expanded, understanding the factors associated with repair failure has become increasingly important. The purpose of this review is to synthesize contemporary evidence regarding risk factors for failure of meniscal repair, clarify how failure is defined and evaluated, and outline current strategies for management of failed repairs to guide clinical decision-making.</p> Recent Findings <p>Recent literature supports meniscal repair as a joint-preserving procedure with superior long-term outcomes compared with meniscectomy, though failure and reoperation remain clinically relevant concerns. Failure risk is influenced by a combination of patient-related factors, including smoking status, limb alignment, and medical comorbidities; tear characteristics such as vascular zone, tear pattern, chronicity, and meniscal laterality; and surgical variables including isolated repair versus concomitant ligament reconstruction, repair technique, and postoperative rehabilitation. Advances in repair devices, imaging, and biologic augmentation have improved healing potential, and growing evidence supports revision meniscal repair in select patients with favorable tissue quality and tear morphology.</p> Summary <p>Meniscal repair failure is multifactorial and cannot be attributed to surgical technique alone. Successful outcomes depend on appropriate patient selection, careful assessment of tear biomechanics, selection of an optimal repair strategy, and individualized rehabilitation. Revision meniscal repair remains a viable option for preserving meniscal function in appropriately selected patients. Future research should prioritize standardized definitions of failure, comparative studies of repair techniques, and biologic strategies to further improve healing and long-term joint preservation.</p>