Mid-term evaluation of clinical and functional outcomes after arthroscopic medial longitudinal and bucket-handle meniscus repair

Objectives: The aim of this study was to evaluate clinical and functional outcomes following the arthroscopic medial meniscal repair. Patients and methods: A total of 50 patients (42 males, 8 females; mean age: 32.9±7.6 years; range, 17 to 48 years) who underwent arthroscopic repair for longitudinal and bucket-handle medial meniscal tears between March 2005 and October 2011 were retrospectively evaluated. The patients were divided into two groups as those having a longitudinal tear (patient group, n=31) and having a bucket-handle tear (control group, n=19). Preoperative and final follow-up functional outcomes were evaluated using the Lysholm Knee Score (LKS), International Knee Documentation Committee (IKDC) score, Tegner Activity Scale (TAS) score, and Knee Injury and Osteoarthritis Outcome Score (KOOS). Results: The mean follow-up was 61.7±22.8 (range, 36 to 110) months. The mean preoperative LKS, IKDC score, TAS, and KOOS scores were significantly improved at the final postoperative follow-up (p<0.05). There was no significant difference in functional outcome scores between longitudinal and bucket-handle repairs (p>0.05), and isolated repairs and concomitant meniscal repair and anterior cruciate ligament reconstruction (p>0.05). Conclusion: Arthroscopic meniscal repair provides similar mid-term functional and clinical outcomes for longitudinal and bucket-handle medial meniscal tears. Concomitant meniscal repair does not seem to affect meniscal healing.

Numerical Investigation of the Effects of Bucket Handle Tears and Subtotal Medial Meniscectomies on the Biomechanical Response of Human Knee Joints

Understanding the complex biomechanical behaviour of the injured and meniscectomised knee joints is of utmost significance in various clinical circumstances. The objective of this study is to investigate the effects of bucket handle tears in the medial meniscus and subtotal medial meniscectomies on the biomechanical response of the knee joints belonging to multiple subjects. The three-dimensional (3D) finite element models of human knee joints including bones, cartilages, menisci, ligaments and tendons are developed from magnetic resonance images (MRI) of multiple healthy subjects. The knee joints are subjected to an axial compressive force, which corresponds to the force of the gait cycle for the full extension position of the knee joint. Three different conditions are compared: intact knee joints, knee joints with bucket handle tears in the medial meniscus and knee joints after subtotal meniscectomies. The bucket handle tear causes a considerable rise in the maximum principal stress at its tip compared to that at the same location in the intact meniscus. This would cause the total rupture of the meniscus resulting in cartilage damage. Subtotal meniscectomy causes a considerable reduction in the contact area along with a substantial increase in the contact pressure and maximum compressive stress in the cartilages in comparison with that in the intact knee. This could give rise to severe degenerative changes in the cartilage. The results of this study could help surgeons in making clinical decisions when managing patients with meniscal injuries.

Comparison of Cases with Anterior Cruciate Ligament Reconstruction Accompanied by Simultaneous Medial Meniscus Bucket Handle Tear Repair and Isolated Medial Meniscus Bucket Handle Tear Repair

The aim of this study was to evaluate the success of the all-inside repair technique for medial bucket-handle meniscus tear (BHMT) and the factors affecting healing. A total of 36 patients with BHMT who were operated between 2012 and 2018 and completed final follow-up examinations were included in the study. Functional evaluation was made with the International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner score. Healing was evaluated on magnetic resonance imaging (MRI) slices. The patients were evaluated with respect to the effect on healing of factors such as demographic data, body mass index (BMI), smoking status, anterior cruciate ligament tear reconstruction (ACLTR) applied at the same time as BHMT repair, and the tear being chronic or acute. The mean age of the patients was 28.6 ± 8.6 years (range,18–46 years), the mean follow-up period was 25.8 ± 13.9 months (range, 13–59 months), and BMI was mean 25.6 ± 3.5 kg/m2 (range, 20.1–30.5 kg/m2). The meniscus tears were acute in 16 (44.4%) patients and chronic in 20 (55.6%). ACLTR was applied together with BHMT repair in 25 patients. The hybrid technique, as the outside-in technique in addition to the all-inside technique, was applied to 12 (33.3%) patients, where there was seen to be extension to the anterior horn. The failure rate was determined as 27.8% according to the postoperative MRI evaluation and the Barrett criteria. No positive or negative statistically significant effect on healing was determined of chronic BHMT or of simultaneous application of ACLTR (p = 1.00 and 0.457, respectively). Cigarette smoking and high BMI were determined to have a statistically significant negative effect on healing (p = 0.026 and 0.007, respectively). In conclusion, it can be seen that the success of the all-inside technique for BHMT remains controversial. Due to the features of the application, it can be used in meniscus tears of the posterior horn only. In the current study, with the success rate of 72.2% of the all-inside technique in meniscus body tears, it was seen that a high success rate could not be achieved.

Bucket Handle Tear of Lateral Meniscus on MRI - A Case Report

Bucket handle tear commonly involved the medial meniscus but lateral meniscus are also involved though less commonly. The characteristic imaging appearance on MRI are important to diagnose the condition.