Arthroscopic Procedure for Chronic Isolated Bucket-Handle Meniscal Tears

Abstract

Arthroscopic treatment is the treatment of choice in bucket-handle meniscal tears (BHMTs). Following BHMT, however, surgery failure rates are approximately 20% in the literature. Achieving the healing of BHMT is difficult. This is worse in chronic situations because the torn meniscus is deformed, leading to nonanatomical reduction. Some authors have reported greater failure rates, especially in the early postoperative period. In isolated BHMTs, the failure rate is greater because of inadequate and incomplete repairs due to the tight medial compartment. Multiple techniques for possible reduction of failure rate have been described. We describe an arthroscopic technique for treating chronic isolated BHMT using the technique of subcutaneously releasing the posterior fibers of the medial collateral ligament to provide adequate space for arthroscopy, meniscal reduction, and repair. A combined inside-out and all-inside repair technique was used to enhance anatomic reduction, stable fixation, surface fixation (rather than the usual suture-points fixation), and biologic healing in repairable chronic BHMTs.

Long-term clinical results of using a posteromedial all-inside and anteromedial inside-out approach to repair unstable or irreducible bucket-handle medial meniscal tears

“…The stable repair technique performed in this study allowed the surgeon to begin early knee ROM up to 45° for all patients. It is reported that other techniques do not allow early knee ROM until during the first 2 weeks after surgery [11,12,16,17].…”

“…MCL trephination is often necessary to create more space [21,22]. Iatrogenic chondral lesions and residual unrepaired tears are morbidities that prevent symptoms from being adequately relieved, thus leading to higher failure rates [11]. It is difficult to visualize the posterior horn of the medial meniscus with classic anterior portals, which may result in the blind placement of sutures and insufficient debridement of the chronic meniscal tear borders [15].…”

“…In this study, posterior portals were used to enable meniscal posterior border abrasion and fibrous tissue removal. Freshening the meniscal borders was the first step toward meniscal repair [8,24], and posterior arthroscopy facilitated vertical mattress suture placement with high biomechanical strength to allow contact surface instead of point contact repair [11,16,25].…”

“…In irreducible cases, the displaced central fragment is rotated 180° or more, meaning that reduction is impossible without derotation. In chronic cases, the rotated meniscus is deformed and degenerated; thus, the issue of instability arises [11]. Although reduction is sometimes possible in chronic cases, the reduced and deformed fragment does not remain in the anatomical position and is immediately displaced into the notch, making repair impossible [11].…”

Is posterior knee arthroscopy using posterior portals necessary for orthopedic surgeons? The latest evidence on applications and techniques

“…Despite the high learning curve, vertical mattress sutures to repair the posterior meniscus are only possible with posterior arthroscopy. These sutures allow contact surface repair instead of point contact repair ( 13 ) with higher torsional strength and healing rate ( 14 ). Posterior arthroscopy is the most suitable method to reduce the sagging of the peripheral piece of the posterior meniscus to provide anatomic reduction ( 2 ) ( Fig.…”