A Bucket Handle Tear: Is Meniscal Repair Or Meniscectomy The Best Option?

Has Your Knee Kicked The Bucket?

A meniscus tear is a knee injury that is especially common in contact sports. The menisci are a pair of c-shaped cartilage that sit on top of the tibia. The cartilage helps shock absorption of the lower leg, especially when performing activities like running. Meniscus tears can happen due to wear and tear, but most knee injuries are caused by collisions or unnatural twisting of the leg. One common type of meniscus tear, called a bucket handle tear, requires surgery to restore proper knee function. With the help of a surgeon, the patient can determine whether meniscal repair or meniscectomy is the best surgical approach.

Dissecting types of meniscus tears

The meniscus can tear in multiple ways. The type of tear determines the best treatment available. With a bucket handle tear, the center part of the meniscus tears and separates. This displaced tear resembles a bucket handle. The torn part flips over and becomes lodged within the joint, often causing a catching sensation or reduced movement. This type of tear typically occurs in the medial meniscus and will significantly limit movement. Common symptoms of a bucket handle tear include sudden, sharp knee pain, swelling, and joint stiffness. Along with the catching sensation, there is difficulty bearing weight on the knee. A bucket handle tear can only be diagnosed with imaging tests. A doctor or surgeon will then recommend meniscal repair or meniscectomy.

Should you consider meniscus repair?

Meniscal repair seeks to reattach the torn cartilage to the meniscus using sutures. The goal is to maintain the structural integrity of the meniscus, which will encourage long-term function. This procedure is often performed arthroscopically, using 2-3 small incisions. Through 1 incision, the surgeon will insert a scope, a device that projects an image of the meniscus damage. A surgical device is passed through the remaining incision to repair the cartilage. Multiple sutures are passed through the meniscus and knotted together to close the bucket tear. The procedure can take several hours. However, due to the minimally invasive nature, the patient can leave on the same day.

Pros and cons of repair

Meniscal repair is preferred as the procedure seeks to preserve as much cartilage as possible. This helps stabilize the knee and improves function. Meniscal repair is also effective for long-term functional outcomes, especially in young people like athletes. There’s also a reduced risk of future injuries or conditions like osteoarthritis. While effective, meniscal repair may not be effective for severe bucket handle tears. Some tears happen in the avascular zone, the area with the least blood supply. Some bucket handle tears repaired arthroscopically can fail to heal effectively, leading to future injuries and surgery.

Fixing the bucket with meniscectomy

A meniscectomy is a more advanced procedure that seeks to remove the damaged cartilage completely. Like meniscal repair, this procedure can be performed arthroscopically, leading to faster healing and smaller scars. During meniscectomy, the surgeon will use a scope to view the damaged meniscus. Next, surgical tools trim away the damaged or degenerated cartilage. The procedure will remove any cartilage restricting the full range of motion (ROM) while preserving any healthy tissue.

Pros and cons of meniscectomy

Meniscectomy removes the damaged tissue, especially those that fail to get adequate blood supply. For some patients, this procedure provides faster pain relief and function. The knee may also respond better to rehabilitation, allowing patients to return to normal activity faster. Meniscectomy can also address more complex tears and is often a more efficient treatment option. The surgery, while effective, can increase the risk of future knee pain, swelling, and discomfort, as there is less cartilage to help with shock absorption. Active patients need to manage knee function to avoid the risk of osteoarthritis. Reduced shock absorption also increases the risk of future knee injuries, such as anterior cruciate ligament (ACL) tears.

Which treatment is better?

Choosing the right procedure depends on the severity of the tear, the patient’s age and health, and the potential for recovery with physiotherapy. The size and location of the tear also matter. With enough blood flow, meniscal repair can provide better long-term outcomes. Meniscal repair is also ideal in younger patients with excellent tissue quality and rehabilitation habits. A minor bucket tear will benefit from meniscal repair. Meniscectomy can help with more severe tears in older patients with lower activity levels but need faster recovery. A surgeon can discuss the pros and cons of the procedure, patient expectations, and long-term outcomes.

Get a handle on your knee injury

A meniscus injury, such as a bucket handle tear, is painful and severely limits knee ROM. Individuals who participate in vigorous activity, like athletes, need surgery to reduce pain and restore function. Both meniscal repair and meniscectomy are effective surgical options. However, the best option depends on the patient’s overall health and goals. With a surgeon’s support, the most appropriate procedure will be used for optimal recovery and long-term function of the joint.