Meniscal preservation beyond 40 – outcomes of arthroscopic repair of chronic bucket-handle tears
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20262042Keywords:
Bucket-handle meniscal tear, Meniscal repair, Meniscectomy, Chronic meniscal tear, Middle-aged patientsAbstract
This case series evaluated the outcomes of arthroscopic repair in five patients aged over 40 years with chronic medial bucket-handle meniscal tears, with a mean symptom duration of nine months. All patients demonstrated intraoperative adhesions (60% classified as major) along with grade 1 to 2 chondral changes. Despite attempted repair, a 100% failure rate was observed within 2 to 5 months, necessitating subsequent meniscectomy in all cases. Functional outcomes, as measured by the IKDC score, showed only modest improvement following repair (38.2%-54.0%), but improved substantially after meniscectomy (77.5% at one year; mean gain of 39.5%). Similarly, pain scores (VAS) demonstrated significant reduction only after meniscectomy (6.6-2.4). These findings suggest that in middle-aged patients with delayed presentation of chronic bucket-handle tears, the likelihood of repair failure is high, and primary or early meniscectomy may represent a more pragmatic treatment strategy.
References
Costa GG, Grassi A, Zocco G, Graceffa A, Lauria M, Fanzone G, et al. What is the failure rate after arthroscopic repair of bucket-handle meniscal tears? A systematic review and meta-analysis. Am J Sports Med. 2022;50(6):1742-52.
Kramer DE, Kalish LA, Martin DJ, Yen YM, Kocher MS, Micheli LJ, et al. Outcomes after the operative treatment of bucket-handle meniscal tears in children and adolescents. Orthop J Sports Med. 2019;7(1):2325967118820305.
Espejo-Reina A, Serrano-Fernández JM, Martín-Castilla B, Estades-Rubio FJ, Briggs KK, Espejo-Baena A. Outcomes after repair of chronic bucket-handle tears of medial meniscus. Arthroscopy. 2014;30(4):492-6.
Muench LN, Achtnich A, Krivec L, Diermeier T, Woertler K, Braun S, et al. Clinical outcome and healing rate after meniscal bucket handle tear repair. BMC Musculoskelet Disord. 2022;23(1):1063.
Noyes FR, Barber-Westin SD. Repair of complex and avascular meniscal tears and meniscal transplantation. J Bone Joint Surg Am. 2010;92(4):1012-29.
Tan JNB, Loh SYJ. An approach to chronic and displaced bucket handles meniscal tear: assessment, repair (push-and-pull technique), or salvage. Arthrosc Tech. 2021;10(7):e1853-7.
Alabi IA, Chernchujit B, Kanokvaleewong C, Artha A, Pena RJ. Arthroscopic procedure for chronic isolated bucket-handle meniscal tears. Arthrosc Tech. 2021;10(2):e375-83.
Jaramillo Quiceno GA, Sarmiento Riveros PA, Arias Pérez RD, Jaramillo FG. Meniscocapsular release technique to reduce chronic and challenging bucket-handle meniscus tear. J ISAKOS. 2024;9(3):418-21.
Lamba A, Hevesi M, Pan X, Boos AM, Wang AS, Levy BA, et al. Long-term comparative outcomes of all-inside versus inside-out repair of bucket-handle meniscal tears: a cohort study. Orthop J Sports Med. 2024;12(12):23259671241296899.
Mordecai SC, Al-Hadithy N, Ware HE, Gupte CM. Treatment of meniscal tears: an evidence-based approach. World J Orthop. 2014;5(3):233-41.
Abusara Z, Andrews SHJ, Von Kossel M, Herzog W. Menisci protect chondrocytes from load-induced injury. Sci Rep. 2018;8(1):14150.
Baratz ME, Fu FH, Mengato R. Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report. Am J Sports Med. 1986;14(4):270-5.
Hurmuz M, Ionac M, Hogea B, Miu CA, Tatu F. Osteoarthritis development following meniscectomy vs meniscal repair for posterior medial meniscus injuries: a systematic review. Medicina (Kaunas). 2024;60(4):569.
Kalifis G, Raoulis V, Panteliadou F, Liantsis A, D’Ambrosi R, Hantes M. Long-term follow-up of bucket-handle meniscal repairs: chondroprotective effect outweighs high failure risk. Knee Surg Sports Traumatol Arthrosc. 2022;30(7):2209-14.
Pawelczyk J, Fanourgiakis I, Feil S, Siebold M, Kougioumtzis I, Siebold R. Good mid- to long-term outcomes after meniscus bucket-handle tear repair: a comparative analysis with and without anterior cruciate ligament reconstruction. J Exp Orthop. 2024;11(3):e12093.
Schippers P, Buschmann V, Wunderlich F, Afghanyar Y, Fischer S, Wegner E, et al. Bucket-handle meniscal tears might not be an urgency: the time to meniscus repair does not seem to affect the mid-term outcome—a retrospective study of sixty tears with a mean follow-up of 6 years. J Clin Med. 2024;13(11):3048.
Rosenberg SI, Ouweleen AJ, Hall TB, Patel NM. Are neighborhood conditions associated with surgical delays and meniscus tears in children and adolescents undergoing ACL reconstruction?. Clin Orthop Relat Res. 2023;481(2):281-8.
Barron DW, Gill VS, Boddu SP, Beckett NC, Tummala SV, Chhabra A. Low income, younger age, female sex, and poor mental health are risk factors for diminished access to care among patients with meniscus tears. Arthrosc Sports Med Rehabil. 2025;7(2):101064.
Downloads
Published
How to Cite
Issue
Section
