Bucket-handle Tear Research Articles

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.

Meniscus transplantation in skeletally immature patients.

Meniscal pathology in skeletally immature patients includes meniscal tears and discoid lateral meniscus. Total or subtotal meniscectomy may occur in patients with discoid lateral meniscus or severe meniscal tears. Meniscal transplantation may be an option in skeletally immature patients status after total or subtotal meniscectomy with knee symptoms or dysfunction. This study focuses on the surgical technique and short-term outcomes of meniscus transplantation in skeletally immature patients. We reviewed our clinical database for skeletally immature patients who had undergone meniscus transplantation with a minimum of 2 years of follow-up. Patients were contacted, invited for a physical exam, and asked to complete a Pedi-IKDC, Lysholm, and Tegner outcomes questionnaire. The study protocol was approved by the responsible institutional review board. Three patients (two females/one male) were eligible for the study, each of whom responded to our invitation indicating availability for physical exam and questionnaire. Two patients had undergone subtotal discoid meniscus resection, leading to early lateral compartment degeneration. One patient developed advanced degeneration after a delay in treatment for a medial bucket-handle tear associated with anterior cruciate ligament rupture. The mean age of the patients at the time of surgery was 12.6±2.3 years. At a mean follow-up of 31±20 months, the mean Pedi-IKDC score was 68.3±4, the mean Lysholm was 55.7±22.3, and the median Tegner was 7 points. There were no indications of growth deformity during the regular postoperative radiological assessments. One patient required subsequent lysis of adhesions along the lateral mini arthrotomy and mobilization under anesthesia. The other two patients were able to return to sports at the same level as before meniscus transplantation and were able to do so within 9 months postoperatively. Over-resection of discoid menisci as well as untreated meniscus injury, the latter typically in conjunction with ligamentous instability, can lead to advanced cartilage degeneration and recalcitrant complaints necessitating surgical treatment before skeletal maturity. We were able to show that meniscus transplantation in skeletally immature patients leads to acceptable clinical outcomes without growth deviation. IV.

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.

Revision Meniscal Surgery in Children and Adolescents

Background: The mechanisms of failure and risk factors for failed meniscal surgery in children and adolescents have not been well described. Purpose: To investigate the risk factors, mechanisms of failure, and subsequent operative management for revision meniscal surgery in a pediatric population, as well as to identify the local incidence of failed meniscal surgery. Study Design: Case-control study; Level of evidence, 3. Methods: All patients younger than 20 years who had arthroscopic management for meniscal injuries at a single institution between 2008 and 2012 underwent retrospective review. 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. Multivariate logistic regression with purposeful selection was performed to identify independent risk factors for revision meniscal surgery. Results: Arthroscopic knee surgery was performed on 293 patients and 324 menisci, including 129 primary repairs, 149 primary partial meniscectomies, and 46 discoid saucerizations ± stabilization. At a mean of 40 months (range, 19-62 months) after surgery, 13% of all menisci required a revision procedure. The primary repair cohort had the highest failure rate (18%), followed by the primary discoid saucerization cohort (15%) and the partial meniscectomy cohort (7%). Multivariate analysis indicated that meniscal repair was predictive of retear (odds ratio, 2.04 [95% CI, 1.01-4.1]; P = .046), and children with an open physis and a bucket-handle tear had the highest retear rate of 46% (P = .039). Independent variables shown to have no significant relationship to revision meniscal surgery included age, sex, body mass index, extremity side, laterality (medial-lateral), time to repair, tear location, and associated ligament reconstruction. The most common indication for revision surgery was an acute reinjury during intense physical activity. Revision procedures were performed at a mean of 14 months after the index procedure, and the majority of failures (83%) were identified within 1 year. Of patients undergoing a revision surgery, 44% underwent a further debridement, whereas 56% underwent a repair. Conclusion: The success rate of meniscal surgery is 87% in children and adolescents. The revision rate was higher when repair was attempted in the index procedure, particularly in those children with open physes and bucket-handle tears. Most failures are the result of an acute reinjury within 1 year, and nearly half will require debridement of the retorn meniscus.

SLAP lesions: a treatment algorithm.

Tears of the superior labrum involving the biceps anchor are a common entity, especially in athletes, and may highly impair shoulder function. If conservative treatment fails, successful arthroscopic repair of symptomatic SLAP lesions has been described in the literature particularly for young athletes. However, the results in throwing athletes are less successful with a significant amount of patients who will not regain their pre-injury level of performance. The clinical results of SLAP repairs in middle-aged and older patients are mixed, with worse results and higher revision rates as compared to younger patients. In this population, tenotomy or tenodesis of the biceps tendon is a viable alternative to SLAP repairs in order to improve clinical outcomes. The present article introduces a treatment algorithm for SLAP lesions based upon the recent literature as well as the authors' clinical experience. The type of lesion, age of patient, concomitant lesions, and functional requirements, as well as sport activity level of the patient, need to be considered. Moreover, normal variations and degenerative changes in the SLAP complex have to be distinguished from "true" SLAP lesions in order to improve results and avoid overtreatment. The suggestion for a treatment algorithm includes: type I: conservative treatment or arthroscopic debridement, type II: SLAP repair or biceps tenotomy/tenodesis, type III: resection of the instable bucket-handle tear, type IV: SLAP repair (biceps tenotomy/tenodesis if >50% of biceps tendon is affected), type V: Bankart repair and SLAP repair, type VI: resection of the flap and SLAP repair, and type VII: refixation of the anterosuperior labrum and SLAP repair.

Displaced Double-Layered Lateral Meniscus That Mimicked the Bucket-Handle Tear: a Case Report

Various different types of meniscal abnormalities have been reported in the literature. Among them, the occurrence of a double-layered lateral meniscus is extremely rare. The double-layered lateral meniscus includes both the upper additional and the lower normal meniscus (1) (Fig. 1). As the upper additional meniscus is mobile, although very rare, it can be displaced and flipped over the intercondylar eminence of tibia, mimicking the bucket-handle tear. In the English literature, there is only one previously published report of a displaced double-layered lateral meniscus that mimicked the bucket-handle tear (2). Here, we describe a rare case of displaced double-layered lateral meniscus mimicking the bucket-handle tear, where a displaced upper additional meniscus was observed in the intercondylar notch of the knee. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Received: August 11, 2016 Revised: September 11, 2016 Accepted: September 12, 2016

Three-dimensional reconstructed magnetic resonance scans: Accuracy in identifying and defining knee meniscal tears.

AIMTo determine whether three-dimensional (3D) reconstruction from conventional magnetic resonance imaging (MRI) is able to accurately detect a meniscal tear, and define the configuration.METHODSThirty-three patients’ 3T MRI scan data were collected and sagittal uni-planar 3D reconstructions performed from the preoperative MRI. There were 24 meniscal tears in 24 patients, and nine controls. All patients had arthroscopic corroboration of MRI findings. Two independent observers prospectively reported on all 33 reconstructions. Meniscal tear presence or absence was noted, and tear configuration subsequently categorised as either radial, bucket-handle, parrot beak, horizontal or complex.RESULTSIdentification of control menisci or meniscal tear presence was excellent (Accuracy: observer 1 = 90.9%; observer 2 = 81.8%). Of the tear configurations, bucket handle tears were accurately identified (Accuracy observer 1 and 2 = 80%). The remaining tear configurations were not accurately discernable.CONCLUSIONUni-planar 3D reconstruction from 3T MRI knee scan sequences are useful in identifying normal menisci and menisci with bucket-handle tears. Advances in MRI sequencing and reconstruction software are awaited for accurate identification of the remaining meniscal tear configurations.

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.

Meniscal tears associated with anterior cruciate ligament injury.

To investigate the frequency of meniscal tear and the location of tear associated with anterior cruciate ligament (ACL) injury. We studied 549 patients (552 knees) who were diagnosed with ACL injury by arthroscopy at our center between January 2006 and March 2014 (8 years and 3 months). The subjects comprised 289 males and 263 females ranging in age from 13 to 66 (mean 26.1) years. The cause of injury was sports-related in 89.1 %, and the mean interval from injury to initial arthroscopy was 23 months. The patients were divided into two groups: arthroscopy performed within 8 weeks after injury (acute group; 256 knees) and more than 8 weeks after injury (chronic group; 296 knees). Frequency of meniscal tear and location of tear were compared between two groups. The incidence of meniscal tear diagnosed by arthroscopic examination was 79.2 % (437 of 552 knees) in all subjects; 72.7 % (186 of 256 knees) in acute group and 84.8 % (251 of 296 knees) in chronic group, and was significantly higher in chronic group. Regarding the locations of meniscal tears, in acute group (186 knees), medial meniscal tear only was found in 20 knees (10.8 %), lateral meniscal tear only in 129 knees (69.4 %), and bilateral (including medial and lateral) meniscal tears in 37 knees (19.9 %). In chronic group (251 knees), medial meniscal tear only was found in 62 knees (24.7 %), lateral meniscal tear only in 85 knees (33.9 %), and bilateral meniscal tears in 104 knees (41.4 %). Lateral meniscal tear was commonly associated with acute ACL injury, while medial meniscal tear with chronic ACL injury. Bucket handle tear was observed in 25 knees (medial: 17 knees, lateral: 8 knees) in acute group, and 81 knees (medial: 69 knees, lateral: 12 knees) in chronic group, and was more common in the chronic group. The incidence of meniscal tear associated with ACL injury is higher in chronic cases; the number of medial meniscal tears is particularly high, many of which require meniscectomy. Early ACL reconstruction is recommended also for the prevention of secondary meniscal tear.

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.

The shoulder.

The shoulder.

Associated tears of the lateral meniscus in anterior cruciate ligament injuries: risk factors for different tear patterns.

BackgroundThe pattern of lateral meniscus tears observed in anterior cruciate ligament (ACL)-injured subjects varies greatly and determines subsequent management. Certain tear patterns with major biomechanical consequences should be repaired in a timely manner. Knowledge about risk factors for such tears may help to identify patients in the early posttraumatic phase and subsequently may improve clinical results.MethodsA database of 268 patients undergoing primary ACL reconstruction was used to identify all patients with isolated ACL tears and patients with an associated tear of the lateral meniscus. Patients who underwent surgery >6 months after the injury were excluded. Based on the arthroscopic appearance of the lateral meniscus, patients were assorted to one of three groups: ‘no tear,’ ‘minor tear,’ and ‘major tear.’ Tear patterns defined as major included root tears, complete radial tears, and unstable longitudinal tears including bucket-handle tears. Univariate analysis was performed by comparing the three groups with regard to gender, age, height, weight, BMI, type of injury (high-impact sport, low-impact sport, and not sports related), and mechanism of injury (non-contact vs. contact). Multivariate logistic regression was carried out to identify independent risk factors for minor and major meniscal tears and to calculate odds ratios (OR).ResultsTwo hundred fifteen patients met the inclusion and exclusion criteria. Of those, 56% had isolated ACL tears, 27% had associated minor tears, and 17% had associated major tears of the lateral meniscus. Univariate analysis revealed significant differences between the three groups for gender (p = 0.002), age groups (p = 0.026), and mechanism of injury (p < 0.001). A contact injury mechanism was a risk factor for minor tears (OR: 4.28) and major tears (OR: 18.49). Additional risk factors for major tears were male gender (OR: 7.38) and age <30 years (OR: 5.85).ConclusionMale patients, patients <30 years, and particularly patients who sustained a contact injury have a high risk for an associated major lateral meniscus tear. Special attention is therefore necessary in those patients and early referral to magnetic resonance imaging and/or arthroscopy is recommended to allow meniscus repair in a timely manner.

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.