Bucket handle meniscus tear repair and treatment options
In this article, Ross Hauser, MD presents 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.
- If you have questions about bucket handle meniscus tear repair and treatment options, get help and information from Caring Medical
Tears are the most common form of meniscal injury, and are generally classified by appearance into four categories: longitudinal tears (also referred to as bucket handle tears), radial tears, horizontal tears, and oblique tears. You can learn more in our companion article on the many types of meniscus tears.
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
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.
It is important to note that 51 patients were chosen for this study either had experienced bucket-handle meniscus tears as an isolated injury OR with concomitant ACL injury.
- 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 than 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 post-operative quality of life of patients with repair success or failure.1
Hemi-bucket tears – risk of non-healing surgery
Doctors at Duke University Medical Center described a type of meniscus flap tear resembling a bucket-handle tear, named a “hemi-bucket-handle.”
- “We describe a type of undersurface flap tear, named a hemi-bucket-handle tear, which resembles a bucket-handle tear. Surgeons at our institution feel this tear would likely not heal if repaired given its predominantly horizontal orientation, and additionally speculate the tear could be overlooked at arthroscopy. Thus, we feel it is important to distinguish this type of tear from the typical bucket-handle tear.4
Is it not a bucket handle meniscus tear after all? Is it ligament damage? The need to treat and access the whole knee
In his paper he notes:
“(Doctors) must be aware of the medical meniscus ligament variants (injuries) of the knee during MR imaging, as they can mimic (look like) meniscal tears. By tracing these ligaments along their entire course from origin to insertion, these variants can be correctly identified.” Or in other words help the doctor treat the right injury.2
Is bucket handle meniscus tear surgery necessary for every patient?
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:
“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.”
Their 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.5
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.”3
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If you have questions about bucket handle meniscus tear repair and treatment options, get help and information from Caring Medical
1 Moses MJ, Wang DE, Weinberg M, Strauss EJ. Clinical outcomes following surgically repaired bucket-handle meniscus tears. The Physician and Sportsmedicine. 2017 Jul 3.
2. See, Poh Lye Paul. “Clinics in diagnostic imaging (177).” Singapore Medical Journal 58.5 (2017): 241.
3. 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]
4. Engstrom BI, Vinson EN, Taylor DC, Garrett WE, Helms CA. Hemi-bucket-handle tears of the meniscus: appearance on MRI and potential surgical implications. Skeletal radiology. 2012 Aug 1;41(8):933-8.
5. 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.