Meniscus Tissue Engineering Scaffolds: Biomaterials, Biofabrication, and Translation.

The meniscus is a fibrocartilaginous tissue essential for load transmission, shock absorption, joint stability, and cartilage protection in the knee. However, its intrinsic healing capacity is severely limited, particularly in the avascular region and in complex defects, often resulting in persistent symptoms, functional impairment, and progressive joint degeneration. Although current clinical interventions, including meniscal repair, partial meniscectomy, allograft transplantation, and scaffold-assisted meniscal substitution, can provide symptomatic and functional improvement in selected patients, durable structural and functional restoration remains difficult to achieve. Meniscus tissue engineering has therefore emerged as a potential strategy for tissue preservation and functional reconstruction. This review synthesizes recent advances in meniscus tissue-engineered scaffolds, focusing on biomaterial systems, biofabrication strategies, and translational progress. Natural polymers, decellularized extracellular matrix, synthetic polymers, and composite materials are discussed according to their respective roles in biological regulation, mechanical support, structural organization, and clinical feasibility. Emerging biofabrication strategies are further analyzed with respect to geometric reconstruction, zonal organization, fibrous anisotropy, and their implications for scaffold evaluation. Finally, current in vitro, preclinical, and clinical evidence is critically examined to identify the key barriers that still limit long-term regeneration and clinical translation.