Suboptimal Clinical and Radiologic Outcomes After Medial Meniscus Posterior Root Tears Repair With Early Partial Weight-Bearing: A Systematic Review.

PURPOSE: To systematically review the available literature on clinical, radiologic, and complication outcomes in patients undergoing medial meniscus posterior root tear repair managed with early partial weight-bearing (PWB) protocols (≤4 weeks postoperatively). METHODS: A literature search of PubMed, Embase, and Scopus was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (accessed May 2025). Studies were included if they reported outcomes after isolated medial meniscus posterior root repair (transtibial pullout or all-inside technique) with PWB initiated at ≤4 weeks and provided patient-reported outcomes (PROs). Exclusion criteria included cadaveric or translational studies, concomitant procedures, absence of PROs, mixed weight-bearing protocols, nonoriginal research designs, and studies with overlapping patient cohorts. Extracted data included demographics, surgical technique, rehabilitation protocol, PROs (International Knee Documentation Committee, Lysholm, Tegner), failure/complication rates, and radiologic findings. Study quality was assessed using the Methodological Index for Non-Randomized Studies criteria. Because of the study heterogeneity, a qualitative synthesis was performed. RESULTS: Of the 758 studies identified, 6 met the inclusion criteria, encompassing 271 patients (57 male, 214 female; mean age 37.7-66.4 years; mean follow-up 24-40.6 months). Both transtibial pullout (222) and all-inside (49) techniques were represented. Across studies, early PWB yielded minor clinical improvements with overall poor PROs. Postoperative International Knee Documentation Committee, Lysholm, and Tegner score ranges were 46.4-70.4, 61.4-87.7, and 3.1-7.7, respectively, reflecting modest improvements that in several cohorts remained below established thresholds for satisfactory clinical outcomes. Radiologic outcomes showed osteoarthritis progression in all studies. Healing outcomes varied substantially across studies. Rates of incomplete healing, defined variably as partial or no healing on magnetic resonance imaging or second-look arthroscopy, ranged from 31.3% to 39.2% among studies reporting healing status. CONCLUSIONS: Early PWB (≤4 weeks) following medial meniscus posterior root tear repair is associated with concerning clinical and radiologic outcomes in the available literature. However, the absence of direct comparative studies precludes causal inference regarding the role of weight-bearing timing. Observed outcomes may be influenced by patient selection, surgical technique, and rehabilitation heterogeneity. LEVEL OF EVIDENCE: Level IV, systematic review of Level III and IV studies.