The purpose of this study was to determine the outcomes after repair of chronic bucket-handle medial meniscal tears by use of magnetic resonance imaging, clinical examination, and patient-reported outcomes.
A retrospective review of patients with chronic bucket-handle medial meniscal tears that had been repaired with meniscal sutures was undertaken. The following criteria for inclusion were adopted: minimum tear length of 2 cm and chronic medial meniscal tear identified at the time of arthroscopy. The tears were susceptible to dislocation with probing. Data collected included demographic, clinical, radiologic, and surgical data. Postoperative healing was assessed with the clinical criteria of Barrett et al. The International Knee Documentation Committee rating, Lysholm score, and Tegner activity level were determined, and postoperative magnetic resonance imaging was used to evaluate healing in accordance with the criteria of Henning et al.
Twenty-four patients fulfilled the inclusion criteria. The mean time from injury to surgery was 10 months (range, 2 to 60 months). Sixteen patients underwent anterior cruciate ligament reconstruction, 1 patient underwent posterior cruciate ligament reconstruction, and 6 patients underwent meniscus repair only. A median of 5 sutures (range, 3 to 6 sutures) were used for repair. Four cases (all of which had undergone meniscus repair only) required revision. Complete healing was achieved in 83% of cases according to the criteria of Barrett et al. The mean follow-up time was 48 months (range, 24 to 112 months). An International Knee Documentation Committee rating of A or B was achieved in the 20 patients who did not require revision. The median Lysholm score was 95 (range, 92 to 100). The median Tegner activity level before injury was 7, and it remained unchanged after surgery in all cases.
This study showed that repair of chronic bucket-handle meniscal tears can lead to good clinical outcomes and a relatively low (17%) failure rate. In addition, repairs of isolated meniscal tears had a significantly higher risk of failure than repairs performed in conjunction with anterior cruciate ligament reconstruction.
Level of Evidence
Level IV, therapeutic case series.
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- Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears.Am J Sports Med. 2010; 38: 1542-1548
- Clinical and radiological results 21 years following successful, isolated, open meniscal repair in stable knee joints.Knee. 2011; 18: 396-401
- Long-term results of arthroscopic meniscal repair. An analysis of isolated tears.Am J Sports Med. 1995; 23: 715-720
- Arthroscopic meniscus repair: Clinical and isokinetic results.Diagn Ther Endosc. 1998; 4: 119-125
- Meniscal repair in the elite athlete: Results of 45 repairs with a minimum 5-year follow-up.Am J Sports Med. 2009; 37: 1131-1134
- Meniscal repair in anterior cruciate ligament reconstruction: A long-term outcome study.Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1729-1734
- Meniscal repair versus partial meniscectomy: A systematic review comparing reoperation rates and clinical outcomes.Arthroscopy. 2011; 27: 1275-1288
- Long-term assessment of arthroscopic meniscus repair: A 13-year follow-up study.Knee. 2002; 9: 181-187
- Meniscal repair and transplantation: Indications, techniques, rehabilitation, and clinical outcome.J Orthop Sports Phys Ther. 2006; 36: 795-814
- Meniscus repair and transplantation: A comprehensive update.J Orthop Sports Phys Ther. 2012; 42: 274-290
- Meniscal repair for radial tears of the midbody of the lateral meniscus.Am J Sports Med. 2010; 38: 2472-2476
- Suturing complete radial tears of the lateral meniscus.Arthroscopy. 2007; 23 (Available online at): 1249.e1-1249.e7
- Management of meniscus tears that extend into the avascular region.Clin Sports Med. 2012; 31: 65-90
- Isolated meniscal repair in the avascular area.Acta Orthop Belg. 2003; 69: 341-345
- White on white meniscal tears: To fix or not to fix?.Knee. 2010; 17: 270-273
- Meniscal repair outcomes at greater than five years: A systematic literature review and meta-analysis.J Bone Joint Surg Am. 2012; 94: 2222-2227
- Diagnostic values of 3 methods for evaluating meniscal healing status after meniscal repair: Comparison among second-look arthroscopy, clinical assessment, and magnetic resonance imaging.Am J Sports Med. 2011; 39: 735-742
- Long-term outcome after meniscal repair.Knee Surg Sports Traumatol Arthrosc. 2011; 19: 236-241
- Meniscal repair in patients with chronic lesions.Acta Ortop Mex. 2008; 22 ([in Spanish]): 12-18
- Meniscal repair using the FasT-Fix device in patients with chronic meniscal lesions.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 546-550
- Repair of locked bucket-handle meniscal tears in knees with chronic anterior cruciate ligament deficiency.Am J Sports Med. 2003; 31: 216-220
- Meniscal repair compared with meniscectomy for bucket-handle medial meniscal tears in anterior cruciate ligament-reconstructed knees.Am J Sports Med. 2003; 31: 718-723
- Second-look arthroscopic evaluation of bucket-handle meniscus tear repairs with anterior cruciate ligament reconstruction: 67 consecutive cases.Arthroscopy. 2008; 24: 1358-1366
- A simple device for inside-out meniscal suture.Arthroscopy. 2004; 20: e85-e87
- Meniscus repair.Am J Sports Med. 1999; 27: 242-250
- Clinical results of meniscus repair in patients 40 years and older.Arthroscopy. 1998; 14: 824-829
- Arthroscopic meniscus repair with a posterior incision.Instr Course Lect. 1988; 37: 209-221
- Evaluation of knee ligament injuries with the IKDC form.Knee Surg Sports Traumatol Arthrosc. 1993; 1: 226-234
- Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale.Am J Sports Med. 1982; 10: 150-154
- Rating Systems in the evaluation of the knee ligament injuries.Clin Orthop Relat Res. 1985; 198: 43-49
- Reliability, validity, and responsiveness of the IKDC score for meniscus injuries of the knee.Arthroscopy. 2007; 23: 839-844
- The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later.Am J Sports Med. 2009; 37: 890-897
- Medial and lateral meniscal tear patterns in anterior cruciate ligament-deficient knees.Am J Sports Med. 2001; 29: 415-419
- Patterns of meniscal injury in the anterior cruciate-deficient knee: A review of the literature.Am J Orthop. 1997; 26: 18-23
- All-inside meniscal repair with bioabsorbable meniscal screws or with bioabsorbable meniscus arrows: A prospective, randomized clinical study with 2-year results.Am J Sports Med. 2010; 38: 2211-2217
- Outcomes of meniscal preservation using all-inside meniscus repair devices.Clin Orthop Relat Res. 2010; 468: 1209-1213
- Meniscal tear repaired with Fast-Fix sutures: Clinical results in stable versus ACL-deficient knees.Arch Orthop Trauma Surg. 2012; 132: 349-356
- Augmentation techniques for isolated meniscal tears.Curr Rev Musculoskelet Med. 2013; 6: 95-101
Accepted: December 30, 2013
Received: June 9, 2013
The authors report the following potential conflict of interest or source of funding: K.K.B. receives support from Smith & Nephew, Ossur, Arthrex, Siemens. Research support to Steadman Philippon Research Institute.
© 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.