Purpose <p>To systematically evaluate clinical outcomes, structural healing, and failure rates following meniscus repair augmented with blood or fibrin clot compared with non-augmented repair when available.</p> Methods <p>A systematic review was performed. Eligible studies were clinical investigations evaluating meniscus repair augmented with blood or fibrin clot and reporting at least one outcome of interest, including patient-reported outcome measures (PROMs), structural healing, or failure or reoperation rates. Due to substantial heterogeneity, outcomes were synthesized descriptively.</p> Results <p>Seven studies comprising 237 repaired menisci were included, including two Level II studies and five Level IV studies. Structural healing outcomes were heterogeneous, with complete healing rates ranging from 24.1% to 91.7%, depending on tear characteristics, assessment modality, and follow-up duration. In Level II studies, fibrin clot augmentation was associated with higher rates of complete healing and numerically lower failure rates compared with controls, although statistical significance was not consistently demonstrated. Across all studies, failure or reoperation rates ranged from 0 to 25%, with higher rates observed in cohorts enriched with degenerative horizontal cleavage tears or complex tear patterns. All studies reporting PROMs demonstrated significant postoperative improvement from baseline, regardless of augmentation strategy.</p> Conclusion <p>Blood or fibrin clot augmentation in meniscus repair is associated with favorable but heterogeneous healing outcomes and generally low failure rates. However, current evidence is limited and inconsistent, and further high-quality studies are required to define its clinical role.</p>