Meniscal healing poses a substantial surgical and biological challenge to surgeons. In addition, meniscectomy places the joint at a high risk of accelerated degeneration. The limited nutrient supply, unique cellular and extracellular makeup, and mechano-physical properties of the meniscus are difficult to replicate once substantial lesions occur. Advancements in treatment modalities to date include the implementation of biological and synthetic scaffolds, cell-based augments, growth factor and cytokine-rich injectables, gene therapies, and pharmacological treatments. The majority of clinical experience to date is with scaffolds and allografts. Prostheses are in early use. It appears, at this time, that the aforementioned therapies under development will likely be combined to both facilitate improved meniscal tear healing and, when indicated, replacement.