Bucket-handle Meniscal Tears Research Articles

Surgical Repair of Neglected Bucket-Handle Meniscal Tears Displaced into the Intercondylar Notch: Clinical and Radiological Results.

The literature contains very limited articles wherein the treatment results of bucket-handle meniscal tears according to various types are evaluated and wherein results for repair of chronic tears are discussed. The objective of this study is a clinical and radiologic evaluation of arthroscopic repair for patients suffering flipped, neglected chronic bucket-handle meniscal tear in the intercondylar notch. A total of 26 patients were evaluated retrospectively. The mean age at the time of surgery was 27 years (range, 16-44). Mean period from meniscal injury to surgery was 28 months (range, 4-96). The mean follow-up period was 31 months (range, 11-67). During the follow-up, the patients were evaluated clinically, functional scores from the International Knee Documentation Committee (IKDC), Lysholm, and Tegner as well as magnetic resonance imaging (MRI). The mean preoperative Lysholm score of 24 increased to 85 postoperatively. Mean IKDC score was 56.3 preoperatively and 84.5 postoperatively. The mean Tegner score of 3.4 increased to 5.6 postoperatively. Mean Lysholm, IKDC, and Tegner scores in the first group were 84, 74, and 5.1, respectively, and in the anterior cruciate ligament (ACL) reconstruction group; 86, 85.9, and 5.8. While 20 (77%) out of 26 patients had none of the clinical findings, 6 patients (23%) presented with these findings. Postoperative MRI assessment revealed meniscal healing in 21 patients (27% complete, 54% partial healing) and no healing in 5 patients (19%). A clinical healing rate of 77% and a radiological healing rate of 81% along with statistically significant increases in Lysholm, IKDC, and Tegner scores prove that the repair option is effective for neglected, chronic bucket-handle meniscal tears flipping to the intercondylar notch. This study showed that good results could be achieved with the repair of neglected, chronic period bucket-handle meniscal tears flipping to the intercondylar notch, whether with an accompanying ACL tear or not.

The Influence of Medical Insurance on Patient Access to Orthopaedic Surgery Sports Medicine Appointments Under the Affordable Care Act.

Background:The goal of the Patient Protection and Affordable Care Act (PPACA) was to expand patient access to health care. Since the rollout of the PPACA, Medicaid patients have demonstrated difficulty obtaining appointments in some specialty care settings.Purpose:To assess the effect of insurance type (Medicaid and private) on patient access to orthopaedic surgery sports medicine specialists for a semiurgent evaluation of a likely operative bucket-handle meniscus tear. The study was designed to determine whether disparities in access exist since the PPACA rollout.Study Design:Cohort study; Level of evidence, 2.Methods:The design was to call 180 orthopaedic surgery sports medicine specialists in 6 representative states (California, Ohio, New York, Florida, Texas, and North Carolina) between June 2015 and December 2015. An appointment was requested for the caller’s fictitious 25-year-old-brother who had suffered a bucket-handle meniscus tear. Each office was called twice to assess the ease of obtaining an appointment: once for patients with Medicaid and once for patients with private insurance. For each call, data pertaining to whether an appointment was given, wait times, and barriers to receiving an appointment were recorded.Results:A total of 177 surgeons were called within the study period. Overall, 27.1% of offices scheduled an appointment for a patient with Medicaid, compared with 91.2% (P < .0001) for a patient with private insurance. Medicaid patients were significantly more likely to be denied an appointment due to lack of referral compared with private patients (40.2% vs 3.7%, P < .0001), and Medicaid patients were more likely to experience longer wait times for an appointment (15 vs 12 days, P < .029). No significant differences were found in patients’ access to orthopaedic surgery sports medicine specialists between Medicaid-expanded and -nonexpanded states. Medicaid reimbursement for knee arthroscopy with meniscus repair was not significantly correlated with appointment success rate or patient waiting periods.Conclusion:Despite the passage of the PPACA, patients with Medicaid have reduced access to care. In addition, patients with Medicaid confront more barriers to receiving appointments than patients with private insurance and wait longer for an appointment.

Comparative Outcomes of All-Inside and Inside-Out Repairs of Bucket-Handle Meniscal Tears

Comparative Outcomes of All-Inside and Inside-Out Repairs of Bucket-Handle Meniscal Tears

Clinical outcomes following surgically repaired bucket-handle meniscus tears

ABSTRACTObjectives: Meniscus tears are one of the most common knee injuries. Our goal is to investigate the failure rate for surgically repaired bucket-handle meniscus tears and compare clinical outcomes of repairs that failed versus those that did not, at a minimum 2-year follow-up interval.Methods: 51 patients were identified in this retrospective cohort study who experienced bucket-handle meniscus tears that were isolated or with concomitant ACL injury. Inclusion criteria included age range from 13–55 years, confirmed bucket-handle meniscus tear by MRI and intraoperatively, and at least two-years of post-operative follow-up following index repair. Demographic data and outcome surveys were collected at a minimum of two-years follow-up after repair.Results: Of the 51 patients that had a bucket-handle meniscal repair, 12 (23.5%) were defined as failures (return of symptoms alongside re-tear in the same zone of the repaired meniscus within two years of surgery). No demographic variables (age, sex, and BMI smoking status, location of tear, or concomitant ACL tear) significantly correlated with failure. The mean of the Sports and Recreation KOOS was significantly lower between the non-failure (87 ± 14.4) and failure (70 ± 17.2) cohorts (p = 0.0072). The Quality of Life subscale was significantly lower between the non-failure (76 ± 15.8) and failure (57 ± 18.2) groups (p = 0.0058). There was a significant difference in the post-operative Lysholm scores (p = 0.0039) with a mean of 90 ± 9.1 for the entire cohort and means of 92 ± 8.4 and 83 ± 8.6, for non-failure and failure groups, respectively.Conclusions: We found a higher failure rate (23.5%) for bucket-handle meniscus repairs at two-year follow up than has been cited in the literature, which is typically less than 20%, with significantly lower KOOS Quality of Life and Sports and Recreation subscales and Lysholm scores for the failure cohort. This is the first study to report these outcome scores solely for bucket-handle meniscus repairs, shedding light on the post-operative quality of life of patients with repair success or failure.

Clinical efficacy of arthroscopic simultaneous treatment for anterior cruciate ligament injury combined with meniscus bucket-handle tear

To explore the clinical efficacy of arthroscopic simultaneous both anterior cruciate ligament (ACL) reconstruction and suture of the meniscus bucket-handle tear (BHT). Between January 2013 and April 2014, 22 patients (22 knees) with ACL injury and BHT, who accorded with the inclusion criteria, were studied. There were 14 males and 8 females with a mean age of 30.68 years (range, 15-44 years). The left side was involved in 10 cases and the right side in 12 cases. Injury located at the medial meniscus in 14 patients, and at the lateral meniscus in 8 patients. The median of interval from injury to operation was 40 days (range, 9 hours to 4 years). BHT was sutured, and then single bundle reconstruction of ACL was performed under arthroscopy. All incisions healed by first intention, and there were no serious complications such as infection, vascular injury, and nerve injury. The patients were followed up for 26.7 months on average (range, 12-42 months). At 6 weeks after operation, one patient had limited motion of the knee, the function was recovered after release under anesthesia; and one patient had joint space tenderness, which was relieved after conservative treatment. The total effective rate was 90.9% (20/22). At last follow-up, the anterior drawer test, Lachman test, and McMurray test were negative in all the cases. The visual analogue scale (VAS), Tegner activity level score, and Lysholm score were significantly improved at 12 months after operation when compared with preoperative scores ( P<0.05). At 6-12 months after operation, complete healing was obtained in 7 cases, and partial healing in 11 cases, and nonunion in 4 cases based on MRI evaluation criteria by Crues et al. There was no rupture of reconstruc-tive ligament during follow-up. Arthroscopic simultaneous both ACL reconstruction and suture of BHT can improve the symptoms, reduce the risk of re-tear of sutured meniscus effectively, delay degeneration of articular cartilage, and maintain the stability of the knee joint.

Tunnel malpositions in anterior cruciate ligament risk cartilaginous changes and bucket-handle meniscal tear: Arthroscopic survey in both primary and revision surgery.

There are not many chances to arthroscopically reassess how graft tunnel malpositions in primary anterior cruciate ligament reconstruction (ACLR) associate with intra-articular degeneration in revision ACLR. This study was aimed to evaluate whether radiographic tunnel position in primary ACLR affect cartilaginous changes and bucket-handle meniscus tears in revision ACLR. Thirty-five patients who underwent revision ACLR were recruited; their primary surgeries were single-bundle reconstructions. Tunnel positions were evaluated using the plain radiographs after primary surgery. The sagittal tunnel positions of the femur (FP) and tibia (TP) were determined on the lateral view. The articular cartilage was evaluated arthroscopically at primary and revision surgery using the International Cartilage Repair Society (ICRS) score. A progression of two grades was considered as cartilaginous changes. Meniscal tears were evaluated with an arthroscopic probe. Logistic regression analysis was conducted using the prevalence of cartilaginous changes or bucket-handle meniscus tears as the dependent variable; tunnel parameters were used as the independent variables. Seven patients (20.0%) had cartilaginous changes and nine patients (25.7%) had bucket-handle tears in the medial meniscus. In logistic regression analysis, %FP [odds ratio (OR): 1.212; P=0.007] and the cut-off of 60% in the FP (OR: 22.000; P=0.008) were correlated with cartilaginous changes. %TP (OR: 1.126; P=0.036) was correlated with the prevalence of bucket-handle meniscus tears. Anterior femoral tunnel malposition in the femur was associated with the cartilaginous changes, and posterior tibial tunnel malposition with the development of bucket-handle meniscus tears.

Arthroscopic repair of bucket-handle meniscus tears: a description of patient demographics and a comparison of patients with and without postoperative re-tear

Arthroscopic repair of bucket-handle meniscus tears: a description of patient demographics and a comparison of patients with and without postoperative re-tear

Medium-term clinical outcome of encircled suture for repair of medial meniscus bucket-handle tear

To investigate the medium-term clinical outcome of encircled suture for repair of medial meniscus bucket-handle tear (BHT). Between March 2011 and June 2013, 78 patients (78 knees) with medial meniscus BHT were treated with encircled suture under arthroscopy. There were 57 males and 21 females with a mean age of 28.3 years (range, 16-39 years). The causes included sports injury in 61 cases, traffic accident injury in 12 cases, and other trauma in 5 cases. Of 78 cases, 35 were acute injury and 43 were chronic injury; 65 cases had combined injury of anterior cruciate ligament rupture. International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner score were 48.2±6.3, 43.6±4.7, and 2.5±0.6, respectively. Barrett's assessment standard, MRI, and arthroscopy examination were used for assessment of meniscus healing. IKDC score, Lysholm score, and Tegner score were used for assessment of knee function. Primary healing of incisions were achieved in all patients, and no complications occurred. All patients were followed up 26-63 months (mean, 42.8 months). BHT recurrence was observed in 2 patients within 1 year. Clinical healing of meniscus tear was obtained in 72 cases (92.3%) according to Barrett's assessment standard. The IKDC score, Lysholm score, and Tegner score were significantly improved to 81.5±5.1, 86.9±3.9, and 6.2±0.5 respectively ( t=-14.598, P=0.000; t=-18.478, P=0.000; t=-3.362, P=0.002). MRI results showed complete healing in 56 cases, incomplete healing in 15 cases, and unhealing in 7 cases at last follow-up, with a total healing rate of 91.0% (71/78) and a complete healing rate of 71.8% (56/78). In 21 cases undergoing arthroscopy at 18-49 months after operation, complete healing and incomplete healing were observed in 17 cases and 4 cases respectively, with a total healing rate of 100% (21/21) and a complete healing rate of 81.0% (17/21). No re-tear occurred. Encircled suture for repair of medial meniscus BHT owns the advantage of firm suturing and good blood supply which can obtain satisfactory medium-term clinical results.

Value of magnetic resonance imaging signs in diagnosis of bucket handle tear

ObjectiveTo detect the value of magnetic resonance imaging (MRI) signs in the diagnosis of bucket-handle meniscal tears of the knee. Patients and methodsFifty-five patients were included in this study whose MRI was read as bucket handle tear. Their ages ranged from 19 to 50 years. All patients had subsequent arthroscopy for surgical confirmation. Results37 cases were proved as bucket-handle tears (true surgical positive) by arthroscopy and 18 cases were proved as non bucket handle (true surgical negative). The specificities of MRI signs alone were absent bow tie 44.4%, fragment in notch 77.8%, coronal truncation 77.8%, anterior flipped meniscus 88.9%, double PCL 100%, double anterior horn 100%, disproportional posterior horn 100%. The specificity of absent bow tie with fragment in notch was 83.3%, with anterior flipped meniscus was 94.4% and with coronal truncation was 100%. Specificity was 94.4% for combined absent bow tie, fragment in notch, coronal truncation while combined absent bow tie, anterior flipped meniscus, fragment in notch as well as absent bow tie, double anterior horn, fragment in notch revealed 100% specificity. ConclusionMRI is highly specific in diagnosing meniscal bucket handle tears in the knee, particularly, when signs are combined.

COMBINED INSIDE-OUT AND ALL-INSIDE TECHNIQUE IN BUCKET-HANDLE MENISCUS TEARS.

ABSTRACTObjective: To determine the outcomes after combined inside-out and all-inside repair technique of bucket-handle meniscus tears. Methods: A retrospective review was made of patients with bucket-handle meniscus tears repaired with combined techniques, using the all-inside technique in posterior meniscal tears and the inside-out technique in the middle part of the meniscal tears. Meniscal healing was assessed clinically using Barrett's criteria and MRI. Results: The study comprised 52 patients with a mean age of 28.4 years old (range, 19-52 years old). The mean follow-up period was 31.3 months (range, 24-59 months). Two patients had ACL re-rupture, and complete meniscal healing was achieved in all but one patient. Although improved from preoperative status, Tegner and Lysholm scores were lower in the ACL reconstructed patients than in the intact ACL patients. Conclusion: Combined inside-out and all-inside meniscal repair technique is a successful and cost-effective treatment method in bucket-handle meniscus tears. Level of Evidence IV, Therapeutic Study.

Does meniscus removal affect ACL-deficient knee laxity? An in vivo study.

The purpose of the present study was to determine, in vivo, the effect of different types of meniscectomy on an ACL-deficient knee. Using a computer-assisted navigation system, 56 consecutive patients (45 men and 11 women) were subjected to a biomechanical testing with Lachman test (AP30), drawer test (AP90), internal/external rotation test, varus/valgus rotation test and pivot-shift test. The patients were divided into three groups according to the status of the medial meniscus. Group BH, 8 patients with bucket-handle tear of medial meniscus underwent a subtotal meniscectomy; Group PHB, 19 patients with posterior horn body of medial meniscus tear underwent a partial meniscectomy; and Group CG with isolated ACL rupture, as a control group, with 29 patients. A significant difference in anterior tibial translation was seen at 30 grades and in 90 grades between BH and PHB groups compared to the CG. In response to pivot-shift test, no significant differences in terms of AREA and POSTERIOR ACC were found among the three groups (n.s). Concerning the anterior displacement of the pivot shift a statistically significant differences among the three tested groups was found. The present study shows that meniscal defects significantly affect the kinematics of an ACL-deficient knee in terms of anterior tibial translation under static and dynamic testing.

Future of 34 meniscectomies after bucket-handle meniscus tear: a retrospective study with a follow-up over 22years.

After a bucket-handle meniscus tear, a partial meniscectomy by arthroscopy is recommended, when a meniscal suture is impossible. Short-term results of meniscectomy after bucket-handle meniscus tear, without cartilage or ligament additional injury, are mostly excellent: pain and blocking disappear, return to sports activities is possible. The aim of this retrospective study is to follow a partial meniscectomy evolution with a long follow-up between March 1990 and April 1994, and a senior surgeon operated 34 meniscectomies for bucket-handle meniscus tear by 34 patients (29 male and 5 female) with a mean age of 31.7years (16-52years) at time of surgery. The bucket-handle meniscus tear had a traumatic etiology on a knee with no cartilage lesion. The functional results were assessed by IKDC subjective score (International Knee Documentation Committee) and ARPEGE score (Association pour la Recherche et la Promotion de l'Etude du Genou). These scores were obtained by phone call questionnaire in March 2014 with a mean follow-up of 22.7years (20-24years). In this study, patients were reviewed and got a clinical examination to determine the Lequesne score, a radiological knee assessment according to Ahlbäck classification and a weight-bearing teleradiography. With an IKDC mean score of 85.8 after surgery, we observed that 29 patients go back to sports activities with the same level as before injury. The level of sports activity, with a regular practice after a mean follow-up of 22.7years, was the same as immediately after surgery or just the level under for 85.3% of patients. With ARPEGE score, 48.5% of patients had a global excellent result and 38.2% had a global good result after a long follow-up. With a mean Lequesne score of 2.38, osteoarthritis of knee is still clinical minimal after meniscectomy at long term. The score was worse after external meniscectomy (EM) than after an internal meniscectomy (IM). 57.7% of patients have osteoarthritis on X-rays. In our study, functional results after partial meniscectomy for bucket-handle meniscus tear are similar than in the literature. More than half of our patients, reviewed after a long follow-up, had radiological osteoarthritis of knee with a variable clinical result, but often minimal to moderate, intensity modulated by the lower limb axis.

A suture technique for easier reduction and repair of bucket-handle meniscal tears while using the all-inside devices.

Arthroscopic repair of bucket-handle meniscal tears is difficult due to their complex pathology. Many meniscal repair techniques such as all-inside, inside-out, and outside-in have been described for the treatment of these tears. Loss of reduction is a likely complication with the use of new-generation, all-inside suture instruments, as the tip of the needle is extracted following advancement of the first implant behind the capsule. The complication may be encountered quite often and renders the use of the meniscus repair instrument unusable and causes an irreparable iatrogenic injury in the meniscus. The application of a simpler and more efficient technique is necessary until surgical experience is gained. The aim of this study was to define a new, simpler, and more efficient combination of suturing method in the treatment of bucket-handle meniscal repairs and minimize the rate of complications which may be caused by this technique.

Self-Reduction of Displaced Bucket-Handle Medial Meniscal Tear in a 71-Year-Old Patient: A Case Report.

Background:Bucket-handle meniscal tears are rare in geriatric patients. Displaced bucket-handle meniscal tears are usually treated operatively. Due to the rarity of these tears in elderly patients and conflicting evidence regarding the use of arthroscopy versus conservative treatment, it is valuable to report the clinical presentation, treatment, and outcome of these injuries in elderly patients.Case Description:We describe a 71-year-old man who presented with an acute, displaced, magnetic resonance imaging (MRI)-confirmed right medial meniscal bucket-handle tear with mild effusion and no signs of degenerative joint disease. On physical examination, the patient was unable to fully extend the right leg due to locking of the knee. At 2-month follow-up, MRI showed mild degenerative changes and an anatomically reduced tear. At 6-month follow-up, the patient reported normal, pain-free knee function, and MRI showed the tear healing in anatomic position with minimal inferior surface changes and no effusion. He returned to his pain-free baseline level of physical activity.Literature Review:Upon review of the English literature, this 71-year-old patient is an exceptional case and one of the oldest patients reported to have sustained a displaced medial meniscal bucket-handle tear treated successfully with nonoperative means. Two reported cases of spontaneously reduced meniscal bucket-handle tears were found in the English literature, although both cases were seen in much younger males and involved the lateral meniscus.Clinical Relevance:This case suggests that in elderly patients with displaced medial meniscus bucket-handle tears that reduce spontaneously, the physician can safely and efficaciously use conservative, nonoperative management to achieve restoration of baseline knee function and anatomic meniscal healing while avoiding the risks of arthroscopic surgery. Surgical intervention for reduction without repair may be an available option, but no literature is present to direct care; however, complete documentation as in the current case would be instructive. Katz et al have reported that physical therapy was as efficacious as surgical intervention, although the specific displaced bucket-handle tear was not reported.

Revision Meniscus Surgery in Children And Adolescents: the Effect Of Skeletal Immaturity

Objectives:The purpose of this study was to investigate the incidence and risk factors for revision meniscus surgery in a pediatric population as well as to describe mechanisms of failure and subsequent operative management.Methods:A retrospective review was performed of all patients under 20 years who had arthroscopic management for meniscus pathology at a single institution between 2008 and 2012. Demographic data and intraoperative findings at the time of the initial surgery were documented. All patients undergoing a second procedure on the same meniscus were further analyzed to calculate the incidence and risk factors for revision surgery. The mechanism and date of reinjury as well as subsequent surgical management were documented. Patients with persistent pain following the initial operation were considered a non-traumatic surgical failure. Multivariate logistic regression with purposeful selection was performed to identify independent risk factors for revision meniscus surgery.Results:Arthroscopic knee surgery was performed on 293 patients and 324 menisci, including 129 repairs, 149 meniscal debridements, and 46 discoid saucerizations. With a minimum follow-up period of 17 months, 13% of the cohort required a revision procedure. The primary repair group had the highest failure rate (18%) followed by the discoid saucerization group (15%) and the meniscus debridement group (7%). Multivariate analysis indicated that meniscus repair was predictive of re-tear (OR = 2.04, 95%CI 1.01-4.1, p=0.046), and children with an open physis and a bucket handle tear had the highest retear rate of 46% (p=0.039). Independent variables shown to have no significant relationship to revision meniscus surgery included: age, gender, BMI, laterality, time to repair, tear location, and associated ligament injury. The most common indication for revision surgery was an acute traumatic re-injury during physical activity. Revision procedures were performed at an average of 14 months after the index surgery and the majority of failures (69%) were identified within a year. 44% of patients undergoing a revision surgery underwent a further debridement whereas 56% underwent a repair.Conclusion:Revision meniscus surgery is not uncommon in pediatric and adolescent patients especially those undergoing a primary repair of a bucket-handle meniscus tear when the physes are still open. Most failures are the result of a traumatic injury and nearly half will require further debridement of the torn meniscus. Surgeons treating meniscal lesions in this young population, as well as children and their families, should be aware of the short-term rate of revision meniscus surgery, especially when they are still skeletally immature.

Influence of Health Insurance Status on the Timing of Surgery and Treatment of Bucket-Handle Meniscus Tears.

BackgroundLack of insurance has been shown to lead to delays in seeking care as well as fewer preventive medicine visits and poorer overall health status.PurposeTo investigate the effects of insurance status on the timing and treatment of patients with bucket-handle meniscus tears.Study DesignCohort study; Level of evidence, 3.MethodsCharts from 2004 to 2013 were retrospectively reviewed for patients diagnosed with bucket-handle meniscus tears. Patients were divided into 2 groups: insured or underinsured. The insured group included patients with commercial insurance or Medicare. The underinsured group included patients with Medicaid or Charity Care. Time intervals were categorized as <6 weeks or ≥6 weeks.ResultsA total of 52 patients were included in this study: 15 (29%) insured and 37 (71%) underinsured. Underinsured patients experienced delays in initial presentation to an orthopaedic surgeon (P = .004), time from magnetic resonance imaging to surgery (P = .01), and time from injury to surgery (P = .007). Repair rates were 40% and 38% (P > .999) for the insured and underinsured, respectively. Repair rates for <6 weeks from injury to surgery were 75% for insured (P = .007) and 100% for underinsured patients (P = .001). Repair rates for ≥6 weeks from injury to surgery were 0% for insured and 30% for underinsured patients. Overall, patients with an injury-to-surgery time of <6 weeks had a significantly higher repair rate (87%) than those managed >6 weeks (19%) (P < .001).ConclusionUnderinsured patients experience significant delays in time to presentation and overall time to surgery. However, the overall repair rate between the insured and underinsured is similar. Regardless of insurance status, patients undergoing arthroscopy within 6 weeks of injury have a significantly higher repair rate than those after 6 weeks.Clinical RelevancePatients undergoing arthroscopy within 6 weeks of injury have a significantly higher repair rate than those after 6 weeks.

Spontaneous healing of a displaced bucket-handle tear of the lateral meniscus in a child.

Bucket-handle tears less frequently occur in the lateral meniscus than in the medial meniscus. An 11-year-old male patient complained of painful swelling and locking due to a displaced bucket-handle tear of the lateral meniscus. We recommended an arthroscopic surgery; however, the patient left the hospital without surgical treatment. Six weeks afterwards, he returned without any complain of pain and he regained full range of motion. The final follow-up magnetic resonance imaging showed reduction of the torn meniscal fragment without any signal changes suggestive of a meniscal tear. We report a rare case of an isolated displaced bucket-handle tear of the lateral meniscus in an 11-year-old patient that healed spontaneously without surgical intervention.

Acute Anterior Cruciate Ligament Injury with Medial and Lateral Bucket-Handle Meniscus Tears

We report the case of a healthy 31-year-old female professional billiard player presented with a 5-day history of severe left knee pain after a fall. A magnetic resonance imaging of the left knee showed that she had suffered an anterior cruciate ligament (ACL) rupture along with buckle-handle tears of both the medial and lateral meniscus. Both of these menisci had flipped anterior and centrally to the femoral condyles and were lodged in the notch. The patient had also suffered a mild injury to the medial collateral ligament. Repair of both menisci was performed using an inside-out technique. Following this, an ACL reconstruction was done using a quadrupled hamstring autograft. Endobutton fixation (Smith & Nephew, Andover, MA) was used on the femur with a screw and sheath used for tibial fixation. The patient tolerated the procedure well and was sent home the same day. This case demonstrates the typical signs and symptoms of a displaced bucket-handle meniscus tear as well as imaging and arthroscopic pictures.

Traumatic Bucket-Handle Tears of Both Menisci with Anterior Cruciate Ligament Injury on the Same Knee - A Case Report

Bucket handle meniscal tears could be degenerative or traumatic. Most traumatic bucket handle tear of the meniscus is unilateral, either medial or lateral, and often associated with various degree injury of anterior cruciate ligament (ACL). However, traumatic bucket handle tear of both medial and lateral menisci on the same knee is very rare, and only cases were reported. We reported a case of traumatic bucket handle meniscal tears of both menisci with ACL partial tear on the same knee. Arthroscopic partial menisectomy for both medial and lateral menisci was successfully performed.

Subtle Bucket-Handle Tear Of A Discoid Lateral Meniscus In A 6 Year Old Girl

We report a subtle bucket-handle tear of discoid lateral meniscus causing knee extension blockage in a 6 year old girl. This rare presentation should be recognised by all orthopaedic surgeons practising arthroscopic surgery.