Early Versus Delayed Weight-Bearing Following Tibial Plateau Fracture Surgery: A Systematic Review and Meta-Analysis

Tibial plateau fractures are complex injuries affecting the knee's load-bearing surface and often require surgical fixation. Traditional rehabilitation protocols favor delayed weight-bearing (DWB) to minimize complications, while emerging evidence suggests early weight-bearing (EWB) may improve functional recovery without increasing risk. This systematic review and meta-analysis evaluated outcomes of EWB versus DWB following surgical treatment of tibial plateau fractures. A comprehensive search identified 10 studies including 940 adult patients. Data on postoperative pain, time to union, delayed union, non-union, and functional outcomes were extracted, and meta-analyses were performed using RevMan 5.4; methodological quality was assessed using the Downs and Black checklist. Early weight-bearing was not associated with increased pain, delayed union, or non-union. Meta-analysis showed no significant differences in Visual Analogue Scale (VAS) pain scores (SMD = 0.06; p = 0.89), time to union (SMD = -0.45; p = 0.32), delayed union (OR = 0.40; p = 0.25), or non-union (OR = 0.14; p = 0.10). Studies reported earlier functional recovery, improved range of motion, and similar complication rates in EWB groups. Overall, early weight-bearing after tibial plateau fracture fixation appears safe and may accelerate functional recovery, though heterogeneity in fracture types and rehabilitation protocols underscores the need for individualized strategies and further high-quality research.