Bucket handle meniscus tear repair and treatment options

Bucket handle meniscus tear repair and treatment options

In this article, Ross Hauser, MD and Katherine L. Worsnick, MPAS, PA-C present information on the bucket handle meniscus tear sometimes overlooked in the doctor-patient consultation. Not all bucket handle meniscus tears need to be operated on. The reasons are presented below.

For many doctors and patients, arthroscopic repair is the treatment of choice for meniscal tears. Indeed in many cases, this is warranted. This article will discuss bucket handle tear surgery, realistic recovery expectations following an arthroscopic bucket handle procedure, and various non-surgical options.

Bucket handle meniscus tear surgery failure rates
23.5% to 34% confirmed by two different studies from surgeons

You go to the orthopedist. You have a bucket handle meniscus tear. A look at an MRI convinces the doctor to offer a recommendation to have suture repair surgery (the doctor will stitch up the tear) as opposed to meniscus tissue removal surgery. The doctor tells you that based on the research, the results from this type of procedure are satisfying. How satisfying? Let’s ask universities researchers in Germany who published these findings in the

In June 2018 German doctors at the University Medical Center Freiburg published these findings that they shared with orthopedic surgeons from around the world in the journal: Archives of Orthopaedic and Trauma Surgery:

  • A total of 38 patients (14 women, 24 men) with bucket handle tears underwent surgical meniscus repair.
  • There were 27 isolated repairs and 11 that occurred within the context of an anterior cruciate ligament (ACL) reconstruction.
  • RESULTS: There were 25 patients with a healed meniscus and 13 (34.2%) that sustained re-rupture and underwent either partial meniscectomy (8 patients) or re-suture (5 patients)
  • Who is at risk for re-rupture and need for a second surgery?
    • “Lower patient age, male gender and higher activity level had the strongest impact to provoke re-rupture.”
  • CONCLUSION: “Clinical outcome after meniscus bucket handle suture is satisfying. Re-rupture rate among this collective was 34.2%.”(1) That is a quote.

How about a second opinion on this?

Doctors at the Department of Orthopaedic Surgery, Division of Sports Medicine , New York University Langone Medical Center, Hospital for Joint Diseases in New York have released a May 2017 study in which they  investigated the failure rate for surgically repaired bucket-handle meniscus tears and compared the numbers in those clinical outcomes of bucket handle meniscus repair failure versus those that did not fail at a minimum 2-year follow-up.

  • 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).
  • The researchers found a higher failure rate (23.5%) for bucket-handle meniscus repairs at two-year follow up that has been cited in the literature, which is typically less than 20%.
  • This is the first study to report these outcome scores solely for bucket-handle meniscus repairs, shedding light on the postoperative quality of life of patients with repair success or failure.(2)

    MRI of the right knee without contrast.Noted are changes in the medial meniscus. See how even the radiologist cannot determine whether this represents a recurrent meniscal tear or is just post surgical changes.

    MRI of the right knee without contrast. Noted are changes in the medial meniscus. See how even the radiologist cannot determine whether this represents a recurrent meniscal tear or is just post-surgical changes.

Is bucket handle meniscus tear surgery necessary for every patient?
The curious case of a 71-year-old patient that shows spontaneous healing is possible. Younger patients should pay attention.

Doctors at the Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine describe the case of a 71-year-old-patient with a bucket handle meniscus tear that healed spontaneously.

Here is what they wrote in the medical journal Geriatric Orthopaedic Surgery & Rehabilitation:

“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.”

So something curious is happening here, something that can affect not only elderly patients by bucket handle injury patients as well.

This case history involves a 71-year-old man with acute, displaced, MRI-confirmed right medial meniscus bucket-handle tear with mild effusion and no signs of degenerative joint disease.

(Displaced bucket handle meniscus tears mean the flap of the tear has moved away from the tear and is pointing forward into the knee. This leads to the characteristic symptoms of knee locking and inability to straighten the knee.)

  • 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. He returned to his pain-free baseline level of physical activity.

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.(3)

We know what the athletes out there are saying – that took 6 months! Yes, but 6 months is less time than 1/3rd of you having to go through a second meniscus surgery. However, there can be a way to speed up and help this spontaneous healing.

The evidence for Platelet Rich Plasma therapy and Prolotherapy for Meniscus Tears

One of the treatments we offer to help accelerate and augment non-surgical repair of meniscus injury in Platelet Rich Plasma Therapy combined with Prolotherapy. In the video below a general description and demonstration of the treatment is offered.

Writing in the Physical Medicine and Rehabilitation the journal of injury, function, and rehabilitation, Jessica Urzen of the University of Louisville and Brad Fullerton of the Texas A&M’s College of Medicine, reported of a case of a patient with a bucket handle meniscus tear that resolved non-surgically with Platelet Rich Plasma injections.

They report the case of “a 43-year-old man with magnetic resonance imaging-confirmed medial bucket handle meniscal tear who received 3 treatments of platelet-rich plasma injections in and around the meniscus within 7 months after the diagnosis of the tear. The patient reported resolution of pain with walking 8 months after the injury. Magnetic resonance imaging 10 months after the injury and arthroscopy 47 months after the injury showed complete resolution of the meniscal tear.”(4)

At this point, we are going to ask you to do one of two things. Continue on with your research at our companion articles on PRP and Prolotherapy for meniscus tears where we will explore research on Platelet Rich Plasma therapy for meniscus injury. This is an especially good article is for people exploring the possibility of meniscus arthroscopic surgery, meniscus arthroscopic surgery with PRP augmentation, or PRP injections for meniscus tears as an option. See Platelet rich plasma injections for meniscus tears.

Or if you would like to explore these treatments, ask us your questions.

Prolotherapy Specialists Bucket handle meniscus tear repair and treatment options

If you have questions about bucket handle meniscus tear repair and treatment options, get help and information from Caring Medical

1 Hupperich A, Salzmann GM, Niemeyer P, Feucht M, Eberbach H, Südkamp NP, Kühle J. What are the factors to affect outcome and healing of meniscus bucket handle tears?. Archives of orthopaedic and trauma surgery. 2018 Jun 29:1-9. [Google Scholar]

2 Moses MJ, Wang DE, Weinberg M, Strauss EJ. Clinical outcomes following surgically repaired bucket-handle meniscus tears. The Physician and Sportsmedicine. 2017 Jul 3. [Google Scholar]

3. Ciminero ML, Huntley SR, Ghasem AD, Pitcher JD. Self-reduction of displaced bucket-handle medial meniscal tear in a 71-year-old patient: A case report. Geriatric orthopaedic surgery & rehabilitation. 2015 Dec;6(4):334-7.  [Google Scholar]

4. Urzen JM, Fullerton BD. Nonsurgical Resolution of a Bucket Handle Meniscal Tear: A Case Report. PM&R. 2016 Nov 30;8(11):1115-8. [Pubmed] [Google Scholar]

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