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Cerebral infarction is one of the leading causes of death in adults, impairing patients' quality of life and imposing a heavy burden on families. With current therapeutic approaches, functional recovery after cerebral infarction remains suboptimal. Mesenchymal stem cells (MSCs), due to their broad availability, low immunogenicity, and multipotent differentiation potential, have promise in the treatment of ischemic cerebral infarction. The present study aimed to evaluate the efficacy and safety of mesenchymal stem cells in the treatment of cerebral infarction. VIP Information, China National Knowledge Infrastructure, Wanfang Data, PubMed, Cochrane Library and Web of Science were systematically searched up to October 2024 using the search terms 'mesenchymal stem cells', 'cerebral infarction', and 'randomized controlled trials', which yielded 19 randomized controlled trials for meta-analysis. The efficacy of mesenchymal stem cells in the treatment of cerebral infarction was better than that of conventional treatment, and mesenchymal stem cell therapy decreased the neurological deficit score (National Institutes of Health Stroke Scale) and improved the motor function score (Fugl-Meyer Assessment) and functional independence score (Functional Independence Measure, FIM). Mesenchymal stem cells have a high safety profile in the treatment of patients with cerebral infarction. Most of the adverse effects reported were fever and headache, which resolved spontaneously or following treatment. Umbilical cord mesenchymal stem cells were more effective than bone marrow mesenchymal stem cells. There was no significant difference between transplantation methods. This may be due to the small number of included studies.