Objective To review the biomechanical rationale, surgical techniques, and clinical outcomes of meniscal centralization for degenerative medial meniscus extrusion. Methods A comprehensive literature search was conducted on recent domestic and international studies focusing on biomechanics, surgical methods, and clinical applications of meniscal centralization. Results Meniscus extrusion (radial displacement ≥3 mm beyond the tibial plateau) is commonly associated with degenerative knee conditions, leading to meniscal dysfunction and accelerated osteoarthritis progression. Meniscal centralization is a surgical technique that reduces extrusion by suturing the displaced meniscus back to the tibial plateau, thereby restoring its coverage and load-sharing function. Biomechanical studies have demonstrated its efficacy in reducing extrusion and improving joint contact mechanics. Surgical techniques primarily include the Pull-out method and anchor-based fixation, often supplemented by Pie-crusting release and meniscal mobilization to facilitate reduction. Clinical evidence suggests that centralization, either alone or combined with high tibial osteotomy and/or meniscal root repair, can improve short-term functional scores, reduce extrusion, and potentially delay joint degeneration. Conclusion Meniscal centralization represents a promising joint-preserving technique with favorable biomechanical and early clinical outcomes. However, its long-term efficacy warrants further investigation through high-quality studies.