A Systematic Review and Meta-Analysis of Medial Meniscus Root Tears: Is Surgery the Key to Better Outcomes?

Medial meniscus root tears (MMRTs) are serious injuries that disrupt knee biomechanics, often accelerating cartilage degeneration and osteoarthritis when left untreated. These injuries are increasingly recognized as a major cause of knee pain and functional limitations, particularly among middle-aged and older adults. This systematic review and meta-analysis aimed to evaluate the outcomes of conservative management compared to surgical intervention for MMRT, focusing on pain relief, functional recovery, and the progression of osteoarthritis. A thorough search of PubMed, Scopus, Google Scholar, and the Cochrane Library identified six studies that directly compared surgical repair, primarily transtibial pull-out repair, with conservative management. Outcome measures included the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Lysholm score, and the International Knee Documentation Committee (IKDC) subjective score. Surgical intervention showed marked superiority in KOOS scores, with a standardized mean difference (SMD) of 1.42 (95% CI: 0.97 to 1.88, P < 0.00001), reflecting significant improvements in pain, daily function, and quality of life. However, pooled analyses for the Lysholm score (SMD: 0.21, 95% CI: -0.23 to 0.65, P = 0.35) and IKDC score (SMD: 0.12, 95% CI: -0.56 to 0.80, P = 0.73) did not show statistically significant differences between treatments. High heterogeneity (I² > 50%) was noted, likely due to differences in study populations, follow-up periods, and methodologies. These results suggest that surgical repair offers superior pain relief and functional benefits for MMRT compared to conservative management, positioning it as the preferred option for most patients. Nonetheless, conservative management may remain suitable for certain patients, particularly those with contraindications to surgery. Further high-quality, long-term research is essential to confirm these findings and inform clinical decision-making.