Rosa roxburghii Tratt fruit (RRF), known commonly as Cili in China, is a highly valued fruit that contains abundant functional and nutritional constituents with a variety of health-promoting benefits. Polysaccharides (RRFPs) are regarded as one of the crucial biological compounds in RRF. Existing literature has shown that RRFPs possess various remarkable biological activities, such as antioxidant, hypoglycemic, antitumor, anti-inflammatory, and gut microbiota modulation capabilities. In recent years, isolation and purification methods, structural characteristics, and biological activities of RRFPs have been drawing increasing attention. However, there is no up-to-date review of research progress on this front. In this review, recent advances in RRFPs, including their isolation, purification, structural characterization, biological activity, and the structure-activity relationship are summarized and discussed. In addition, this review highlights the challenges and prospects of RRFPs. Overall, this review provides useful research underpinnings and updated information for the further development and utilization of RRFPs in the fields of health, food, and medicine.