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Meniscal allograft transplantation is a technically demanding procedure that is useful to improve patient satisfaction after total or subtotal meniscectomy. While not yet shown to be chondroprotective, it reliably improves patient subjective outcome measures over the short- to midterm follow-up period. Key factors to consider to improve outcomes include the alignment of the lower limb, the degree of cartilage wear based on the Outerbridge scale, and graft factors such as size, method of preservation, and method of fixation. Patient factors such as excessive body mass index and smoking may be relative contraindications to the procedure. Staged procedures such as high tibial osteotomy or distal femoral osteotomy may be indicated to ensure maximum outcome of the procedure. Grafts may be fashioned using bone plugs for each root, a bone bridge containing both roots, or may use soft tissue only. Open and arthroscopic techniques of meniscus transplant have been used. The most common ligament reconstruction and meniscus allograft combination has been an ACL reconstruction in conjunction with medial meniscal allograft transplantation. Its use in conjunction with the treatment of the multiple ligament-injured knee is limited to very specific cases, and little clinical evidence outside of case reports has been published to guide decision-making in this challenging treatment environment associated with such major knee injuries.