Bucket Handle meniscus tear

What is Bucket Handle meniscus tear?

The meniscus is a cartilage present in the knee joint. The knee is composed of two menisci, one located in the inner side of the knee (medial meniscus) and one located in the outer side of the knee (lateral meniscus). The meniscus function is to help distribute the force across the joint. Bucket Handle meniscus tears are serious injuries that occur when the meniscus separates around the circumference and its inner margin becomes displaced. The torn meniscus tends to flip over into the joint.

What symptoms should I experience?

The symptoms of a Bucket Handle meniscus tear are similar to a typical meniscus tear. It will also present as a locked knee joint that will result in unsuccessful fully straightened knee from a flexed position. Common symptoms include pain, feeling as though the knee is catching, swelling, instability of the knee, and buckling of the knee. Patients may have episodes where the Bucket Handle meniscus tear flips back into place and will experience periods of no symptoms and will feel normal. Eventually, it will flip back causing pain due to a wrong movement at the knee.

What are the causes of Bucket Handle meniscus tears?

Bucket Handle mensiscus tear can occur at any age but are most commonly seen in young athletes. Meniscus tears commonly take place after twisting injuries such as planting the knee and foot down forcefully and turning too quickly. Other causes of meniscus tear include a misstep that causes a twisting at the knee or squatting. Some patients may present with a meniscus tear due to arthritis. Patients with arthritis will present with bones of the knee joint that rub against each other creating irregular and rough surfaces that will increase the risk of Bucket Handle meniscus tears.

When to see the Orthopaedic Surgeon?

Visit the Orthopaedic Surgeon if there is a distinct “pop” in the knee joint while performing your daily living activities, pain that limits activities, swelling of the knee area, and most important locking of the knee. The history of the symptoms in combination with a physical exam will require an MRI to confirm the diagnosis. On MRI the bucket handle meniscus tear will present as a double posterior cruciate ligament (PCL).

What treatments are available for Bucket Handle meniscus tears?

An asymptomatic meniscus tear can have conservative management that includes rest, ice and nonsteroid anti-inflammatory medication. When the meniscus tear becomes symptomatic, the ideal treatment is surgery. Knee arthroscopy involves making small incisions and inserting instruments through the incisions to access the knee joint and repair the damage meniscus. Meniscus tear are typically repaired through partial menisectomy, but this is not the best option for Bucket Handle meniscus tear. Arthroscopy with Circumferential Compression Stitch is the best option for the treatment of Bucket Handle meniscus tear. The use of stitches to align the edges and uniformly compress them together during the healing process to restore their the meniscus anatomical orientation.

What is the prognosis?

After surgery, it is recommended that the patient do not bear weight on the affected leg for approximately six weeks. Physical therapy three times a week for the next four weeks post surgery will be very important during the recovery. The patient will be reevaluated by the doctor at two week post surgery and again at four week post surgery to assess the progress during the recovery. Physical therapy will increase stability, mobility and flexibility of in the knee.

Author Luis G. Colon Gonzalez MS3 Third year medical student at University of Medicine and Health Sciences (UMHS)