Efficacy of repair techniques for meniscal root tears: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVES: Meniscal root tears significantly impair knee biomechanics and can lead to early osteoarthritis if left untreated. This study aimed to systematically evaluate and compare the efficacy of different treatment techniques in patients with meniscal root tears. METHODS: A comprehensive literature search was conducted using specific MeSH terms and related keywords. Data were extracted independently by two reviewers and analyzed using a random-effects model. Outcomes assessed included Lysholm score, International Knee Documentation Committee (IKDC) score, and medial meniscus extrusion (MME). RESULTS: Thirty-three studies were included. Both pull-out and all-inside repairs demonstrated significant improvements in functional outcomes. For Lysholm scores, pull-out repair showed a mean difference (MD) of 29.9 (95% CI 26.7-33.0; I² = 97%), and all-inside repair showed an MD of 39.7 (95% CI 31.6-47.8; I² = 98%). Improvements were smaller following partial meniscectomy (MD 23.5, 95% CI 15.6-31.4; I² = 98%) and conservative treatment (MD 16.9, 95% CI 1.8-32.0; I² = 74%). IKDC outcomes mirrored these findings, with pull-out repair yielding an MD of 28.8 (95% CI 26.5-31.2; I² = 86%) and all-inside repair an MD of 33.9 (95% CI 17.4-50.4; I² = 98%). Partial meniscectomy (MD 16.7, 95% CI - 1.2-45.6; I² = 98%) and conservative care (MD 16.2, 95% CI - 3.6-36.0; I² = 90%) showed non-significant or modest gains. None of the interventions, including pull-out repair (MD - 0.1 mm, 95% CI - 0.5-0.4; I² = 93%) or all-inside repair (MD 0.0 mm, 95% CI - 0.4-0.4; I² = 0%), resulted in significant improvements in medial meniscal extrusion. CONCLUSIONS: Anatomical repair techniques, particularly pull-out and all-inside methods, appear to provide better functional outcomes for meniscal root tears than partial meniscectomy or conservative care. However, given the low certainty of evidence, further high-quality studies are needed to clarify structural outcomes and optimize long-term joint preservation strategies.