Table 1. Descriptive details of all the studies included in this systemic review.

ACL, anterior cruciate ligament; CI, confidence interval; IKDC, International Knee Documentation Committee; MMPRTs, medial meniscus posterior root tear; MMRT, medial meniscus root tear; MRI, magnetic resonance imaging; SF-12, 12 Item Short Form Health Survey; TKR, total knee replacement; VAS, visual analog scale; WOMAC, McMaster Universities Osteoarthritis Index; WOMET, Western Ontario Meniscal Evaluation Tool

M, R, and S groups refer to the meniscectomy, repair, and sham surgery groups, respectively.

Author	Year	Study design	No. of participants	Suture technique/surgical treatment	Outcome measure	Post-operative rehabilitation	Follow-up	Adverse effects	Main findings	Conclusion
Ahn et al. [22]	2010	Retrospective, comparative, cross-sectional, clinical study	38	Pull-out repair	IKDC and Tegner Lysholm Knee Score	_	24 months	Adverse effects were not reported in the study.	The MMRT pull-out repair group demonstrated statistically significant improvements in both the Tegner and Lysholm activity scale and IKDC score (p = 0.017 and p< 0.001, respectively). No statistically significant differences were seen between the alignment and conservative groups (p=0.487).	The intervention group demonstrated better outcomes compared to conservative approaches.
Tachibana et al. [23]	2010	Retrospective study	46	Fast-Fix technique	Second look arthroscopy	For two weeks, the knee was immobilized at 0 degrees of extension in a hinged long leg brace. As soon as the knee could withstand it, partial weight-bearing with crutch support was permitted. Exercises were allowed after 2 weeks, and at 3 weeks, full weight-bearing with discarded crutches was allowed. Spots were not allowed for 8 to 10 months, while pivoting and squatting were not allowed for 3 months.	3 months	Joint tenderness was reported in seven patients, whereas persistent swelling was seen in one patient in knee area. Three patients had a loss of flexion at ≥10o.	48% (30) of menisci demonstrated full healing of the originally formed tear sites without forming new tears.	Fast-fix meniscal repair in conjunction with the reconstruction of the anterior cruciate ligament was successful in almost 74% of the cases. Approximately 83% of the meniscal repair was symptom-free regardless of the integrity of the meniscal.
Kim et al. [24]	2011	A comparative, prospective study	58 (M group, n=28), (R group, n=30)	Partial meniscectomy and pull-out repair	IKDC and Tegner Lysholm Knee Score	_	24-65 months	Two patients lost the fixation strength, while two patients lost restoration of hoop tension	Both groups showed improved levels of IKDC and Lysholm scores (p=0.5). However, the Repair group had better IDKC and Lysholm scores, as well as lower joint progression and narrowing of the Kellgren-Lawrance grade compared to group M	An MRI and second-look arthroscopy revealed sound healing with restoration of the meniscus's hoop tension, and arthroscopic pull-out repair of a medial meniscal reconstruction produced noticeably superior clinical and radiologic outcomes than partial meniscectomy. The findings suggested that the arthroscopic pull-out repair technique is a useful therapy for MMRT.
Sihvonen et al. [17]	2013	Sham-controlled, randomized, multicenter, and double-blind trial	146	Sham surgery and arthroscopic partial meniscectomy	Tegner Lysholm Knee Score and WOMET	_	12 months	Adverse events were seen in one patient who underwent partial meniscectomy. Deep infection of the index knee was observed after 4 months.	The Lysholm score was 21.7 in the partial meniscectomy group as compared to 23.3 points in group S (95% CI: -7.2 to 4.0). The WOMET scores were 27.1 and 24.6, respectively (95% CI: -9.2 to 4.1), and the knee pain scores after physical exercise were 3.3 and 3.1 points, respectively (95% CI: -0.9 to 0.7)	The results of a partial meniscectomy performed via arthroscopy were identical and superior to those of a sham procedure.
Yim et al. [18]	2013	Randomized controlled trial, level I evidence	102	Arthroscopic partial meniscectomy and physical therapy	Lysholm	Partial weight-bearing exercises were carried out for almost 6 weeks. Closed kinetic chain strengthening exercises and full weight-bearing exercises were permitted after 6 weeks of surgery. Light running was permitted after 3 and sports after 6 months. Progressive and strengthening exercises were permitted within the tolerable range.	6 weeks to 123 months	Adverse effects were not mentioned in the study	At the final follow-up (2 years), Lysholm knee scores were 84.3 and 83.2 in the non-operative management and meniscectomy groups, respectively (p = 0.237).	There were no statistically significant differences observed between non-operative management and arthroscopic meniscectomy with stretching and strengthening exercises in terms of satisfaction, relief of knee pain, and knee function in a 2-year follow-up.
Katz et al. [20]	2013	Randomized controlled trial	351	Arthroscopic partial meniscectomy and physical therapy	WOMAC	-	6-12 months	Serious adverse events were reported in three patients in the surgery group and in two patients in the physical therapy arm	At 6 months, WOMAC score was 20.9 in the surgical group and 18.5 in the non-surgical group	No significant difference was seen in both groups
Lee et al. [25]	2014	A retrospective comparative study, level III evidence	50 (n=25 Mason-Allen group; M), (n=25, Controlled group; S)	Mason –Allen stich and simple stich	IKDC and Tegner Lysholm Knee Score	Knee exercises within a range of motion by the use of a continuous passive motion machine, and isometric exercises after a day of surgery. Partial weight-bearing with the aid of a crutch was allowed for 6 weeks.	3 to 36 months	Adverse effects were not mentioned in the study	The repaired meniscal tear tended to heal better in the M group than in the S group (p=0.065). Postoperative clinical outcomes did not differ between the two groups.	Mason–Allen stitches have an improved degree of meniscal extrusion when compared with simple stitches.
Chung et al. [26]	2015	Retrospective, comparative study, level III evidence	57 (M, n=20), (R, n=37)	Partial meniscectomy and pull-out repair technique		_	5 years	Adverse effects were not mentioned in the accessed article.	Results of this study reported that the R group had significantly better IDKC and Lysholm scores (p = 0.002 and p < 0.002, respectively) than the M group	Refixation was found to be more effective for MMPRTs than partial meniscectomy in terms of radiological and clinical survival outcomes for a 5-year follow-up. Refixation did not prevent the progression of arthrosis completely but slowed the progression of arthritic changes.
Pan et al. [27]	2015	Prospective, comparative study	31	Pull-out repair and conservative	IKDC and Tegner Lysholm Knee Score	_	3-26 months	Adverse effects were not reported in the study.	The difference between IDKC and Lysholm scores was not statistically significant for the two groups. However, after operative treatment, patients had higher functional scores and lower osteoarthritis with a significance of p< 0.05.	Both techniques have effectively improved the knee function but surgical technique has improved functional scores of the knee and lowered the osteoarthritis.
Tjoumakaris et al. [28]	2015	Prospective evaluative study	9	Pull-out and repair techniques	WOMAC and Lysholm	_	30 months	Adverse impacts were not reported	Extrusion averaged 1.0 mm in patients with evidence. The Lysholm and WOMAC scores were 81.6 and 11.2, respectively. No correlation was found and series scores.	Four patients showed a recurrence of tears. There was also an increase in the peripheral meniscus tear far from the repairing site, indicating the excessive stress induced by the repair.
LaPrade et al. [29]	2017	Cohort study, level III evidence	50 (15 lateral, 35 medial)	Lateral versus medial pull-out repair	Tegner Lysholm Knee Score, WOMAC, SF-12	Non-weight-bearing exercises were allowed for the first 6 weeks. Quadriceps strengthening and passive knee range-of-motion exercises were allowed after a day of surgery. Partial weight-bearing exercises were allowed after 7 weeks. Strength and endurance exercises were allowed after 2 months. Patients can come back to normal routine after 6 months.	2 years	Not reported	All failures occurred in patients <50 years of age and those who underwent medial root repair. There was no significant difference in failure based on laterality and age (p = 0.541 and p = 0.544, respectively).	After surgery, posterior meniscal root outcomes were improved significantly. The transtibial double-tunnel pull-out meniscal repair improved patient satisfaction.
Chung et al. [30]	2017	Case-control study, level III evidence	39 (23 increased extrusion, 16 decreased extrusion)	Meniscus repair, increased versus decreased extrusion	IKDC and Tegner Lysholm Knee Score	_	5 years	Not reported	The results of this study demonstrate a substantial rise in meniscus extrusion in group A (repair group), with the mean (±SD) increasing from 3.5 ± 0.9 mm before surgery to 5.1 ± 1.4 mm at 1 year postoperatively (p < 0.001). Conversely, in group B (meniscectomy group), there was a significant drop in meniscus extrusion from 4.1 ± 1.3 mm before surgery to 3.5 ± 1.4 mm at 1 year after surgery (p < 0.001).	The results of this study demonstrate that in MMPRT patients, pull-out fixation leads to satisfactory midterm outcomes regardless of the extrusion method at 1-year follow-up.
Furumatsu et al. [31]	2019	A comparative study	39	FasT-Fix versus FasT-Fix modified Mason-Allen stitch	Lysholm, VAS, and KOOS	_	1 year	No reported	KOOS and VAS pain scores and arthroscopic meniscal healing scores of F-MMA pull-out repair were superior to single Fast-Fix pull-out repairs.	F-MMA suture configuration has obtained better meniscal healing and improved clinical outcomes when compared with the single Fast-Fix pull-out repair in people with MMPRTs.
Abdel Tawab Abdallah et al. [8]	2020	Hospital-based prospective study	61	Inside-out technique, all inside and outside-in techniques	IKDC and Tegner Lysholm Knee Score	Partial weight-bearing through crutches, active knee extension and flexion for 6 weeks with a range of motion, stretching, and strengthening exercises for calf muscles and quadriceps with full extension ACL braces for 6 weeks, and passive knee extension and flexion with a motion range of 0-90 gradually for 6 weeks. Quadriceps and hamstring strengthening exercises were performed at 6 weeks	6-12 months	Three patients had a failure to repair	On radiological evaluation, 11 patients show non-healed repair despite having no other clinical symptoms. Three cases presented with MRI grade III intensity, showed clinical symptoms, and underwent revision partial meniscectomy.	The clinical and radiological outcomes of the patients who had MRI follow-ups for 6 months (30 knees) were correlated in all surgical techniques.
Katz et al. [21]	2020	Longitudinal study	351	Arthroscopic partial meniscectomy, physiotherapy	KOOS, TKR	-	5 years	Not reported	The hazard ratio was 2.0 (95% CI: 0.8, 4.9) in arthroscopic partial meniscectomy for total knee replacement compared to physiotherapy in the intent-to-treat group.	TKR is more common in arthroscopic partial meniscectomy compared to the non-operated group.
Rathava et al. [12]	2021	Prospective study	30	Inside-out technique, all inside and outside-in techniques, the hybrid technique was performed arthroscopically	IKDC and Tegner Lysholm Knee Score	Full weight-bearing from the day onward of the surgery, active range of motion from the second day of motion, and strengthening exercises for quadriceps after recovery from anesthesia.	6-12 months	Hemarthrosis was seen in one case, and superficial stitch infection was seen in one case.	The pull-out technique seems to be superior as compared to other techniques as it offers a high rate of meniscus healing without extended time for the operation.	All the repair techniques used for meniscus tears yielded comparative functional and clinical outcomes, and the results of the techniques are not statistically significant. There were good to excellent results in 99.66% of the cases.
Borque et al. [19]	2023	Cohort study, level III evidence	192	All-inside versus Inside-out	_	_	2 years	Not reported	In the first year, 8% of lateral meniscal tears and 16% of medial meniscal tear repairs failed with the inside-out technique and 42% with all-inside techniques.	All inside repair led to a higher rate of failure than inside-out repair of meniscal tears in elite athletes. A higher failure rate was observed in medial than in lateral meniscal repair.