Postoperative rehabilitation after transtibial pullout repair of medial meniscus posterior root tears: A systematic review and meta-analysis.

PURPOSE: To characterise rehabilitation protocols after transtibial pullout repair for medial meniscus posterior root tears (MMPRTs) and evaluate whether study-level rehabilitation parameters were associated with longitudinal changes in patient-reported outcome measures (PROMs).

METHODS

A systematic database search was conducted from inception to 2 June 2025, and updated on 2 February 2026. Study-level data were extracted, including rehabilitation protocols and PROMs. For each study, mean change scores were calculated as the difference between post-operative follow-up and preoperative baseline PROM values. When not reported, the standard deviation of the change score was imputed from baseline and follow-up standard deviations assuming a pre-post correlation (r) of 0.5; sensitivity analyses used r = 0.3 and r = 0.7. Random-effects meta-analysis with Hartung-Knapp adjustment determined overall PROM improvement, and rehabilitation variable effects were tested through study-level meta-regression.

RESULTS

Overall, 31 studies were included, with 17 in the meta-analysis. Pooled mean change scores demonstrated substantial post-operative improvements in International Knee Documentation Committee (IKDC) (28.5 [95% confidence interval [CI] 23.8-33.2]), Knee injury and Osteoarthritis Outcome Score Quality of Life (KOOS QoL) (33.9 [95% CI 22.2-45.6]), KOOS Sport/Rec (33.1 [95% CI 26.0-40.3]), and visual analog scale (VAS) pain (-34.6 [95% CI -40.1 to -29.1]) scores. Pooled estimates were stable using alternative assumptions for change-score variance. Comparing USA and Asian cohorts, bracing duration differed significantly, with USA cohorts more commonly using post-operative bracing for ≥6 weeks; other evaluated rehabilitation variables did not differ significantly. No detectable associations were identified in exploratory study-level meta-regression analyses, although between-study heterogeneity was substantial.

CONCLUSION

Rehabilitation protocols after transtibial pullout repair for MMPRTs are heterogeneous. Patients demonstrated substantial longitudinal PROM improvements; however, no detectable associations were identified between evaluated rehabilitation protocol variables and IKDC improvement. These findings are limited by observational study design, high heterogeneity, ecological bias and insufficient power.

LEVEL OF EVIDENCE: Level IV.