Bucket Handle Meniscus Tears

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The meniscus is a type of cartilage in the knee joint.  In each knee, there are two menisci, one on the inner side of the knee (medial meniscus), and one on the outer side of the knee (lateral meniscus).  The meniscus functions to help distribute force across the joint, and is important in cushioning and protecting the cartilage of the knee.  However, most people are never aware they have a meniscus.

That is, until they injure their meniscus.  Meniscus tears are a common injury to the knee and cause cause pain, swelling, and limited mobility.  One of the most serious types of meniscus tears is called a bucket-handle meniscus tear. 

Bucket Handle Meniscus Tear

A bucket handle tear of the meniscus occurs on the outer portion of the meniscus cartilage, and causes a vertical slice through the meniscus.  The attachments of the meniscus remain in tact, and the torn portion of the meniscus pulls into the center of the joint.  The reason it is called a bucket-handle tear is that the torn segment of the meniscus pulls away forming a handle shaped segment of damaged meniscus tissue.

Symptoms of a bucket handle tear are similar to a typical meniscus tear, however it also typically causes a locked knee joint.  A locked knee occurs when the knee cannot fully straighten from a bent position.  Because the bucket handle fragment of meniscus cartilage is displaced into the front of the joint, it prevents the knee from fully straightening.

Most often, a skilled examiner can determine if a meniscus tear is likely by examining your knee.  Often an MRI is performed to determine the type and location of the meniscus tear.  Bucket handle tears are clearly visible on MRIs, and often show the classic 'double PCL' sign where the meniscus fragment rests along side the PCL causing the ligament to look duplicated.

Bucket handle meniscus tears are often associated with an anterior cruciate ligament injury (ACL tear).  In this common sports injury, one of the major knee ligaments is damaged, and at the same time the bucket handle meniscus tear occurs. 

Treatment Options

The usual treatment is with arthroscopic knee surgery.  While sometimes your doctor can manipulate the tear into proper position, surgery is still needed to address the damage.  Surgery is not an emergency, but should be performed as soon as possible so that the knee can bend and straighten normally.  There are two options for how to manage the torn meniscus:

  • Partial Meniscectomy: This is a surgery performed to remove the damaged portion of meniscus.  The torn meniscus is removed from the joint causing the remaining meniscus to be smaller than normal.  If there is little healing potential of the meniscus, this is the best treatment.  One advantage of removing the torn meniscus is that the recovery is much faster with most athletes returning to sports activities within 6 weeks.
  • Meniscus Repair: A meniscus repair is performed to sew together the torn part of the meniscus back in its proper position.  This procedure is only possible when there is a good blood supply to the area of damage to allow for healing of the tear.  Healing of the meniscus repair requires a much longer rehabilitation that often requires 3 months or longer to return to sports activities.

Source:

Greis PE, et al. "Meniscal Injury: II. Management" J. Am. Acad. Ortho. Surg., May/June 2002; 10: 177 - 187.

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