Arthroscopically Repaired Bucket-Handle Meniscus Tears: Patient Demographics, Postoperative Outcomes, and a Comparison of Success and Failure Cases

Abstract

Objective To define patient demographics, preoperative, and intraoperative surgical variables associated with successful or failed repair of bucket-handle meniscal tears. Design All patients who underwent arthroscopic repair of a bucket-handle meniscus tear at a single institution between May 2011 and July 2016 with minimum 6-month follow-up were retrospectively identified. Patient demographic, preoperative (including imaging), and operative variables were collected and evaluated. A Kaplan-Meier curve was generated to demonstrate meniscus repair survivorship. Results In total, 75 patients (78 knees) with an average age of 26.53 ± 10.67 years met inclusion criteria. The average follow-up was 23.41 ± 16.43 months. Fifteen knees (19.2%) suffered re-tear of the repaired meniscus at an average 12.24 ± 9.50 months postoperatively. Survival analysis demonstrated 93.6% survival at 6 months, 84.6% survival at 1 year, 78.4% survival at 2 years, and 69.9% survival at 3 years. There was significant improvement from baseline to time of final follow-up in all patient-reported outcome ( P < 0.05) except Marx score ( P = 0.933) and SF-12 Mental Subscale ( P = 0.807). The absence of other knee pathology (including ligament tear, contralateral compartment meniscal tear, or cartilage lesions) noted intraoperatively was the only variable significantly associated with repair failure ( P = 0.024). Concurrent anterior cruciate ligament reconstruction (vs. no concurrent anterior cruciate ligament reconstruction) trended toward significance ( P = 0.059) as a factor associated with successful repair. Conclusions With the exception of the absence of other knee pathology (including ligament tear, contralateral compartment meniscal tear, or cartilage lesions) noted intraoperatively, no other variables were significantly associated with re-tear. The results are relatively durable with 84.6% survival at 1 year. Surgeons should attempt meniscal repair when presented with a bucket-handle tear.

All-Inside Repair of Bucket-Handle Meniscal Tears: Clinical Outcomes and Prognostic Factors

“…Fifteen studies § including 396 all-inside repairs for the treatment of BHMTs were included (Table 1). Saltzman et al 34 was included in the results because its original 2018 publication met inclusion criteria for the search. Patient age ranged from 9 37 to 58 42 years with an average of 26.4 years across the 15 included studies, and 64% of the patients were men.…”

“…Six different devices were used in these studies; the Meniscal Repair System fastener (MRSf) (Mitek Products) was used in 1 study, 24 as was the Biofix Arrow 23 (Bionx Implants Ltd). PDS II (polydioxanone) sutures (Ethicon) were used in 2 studies, 2,16 the RapidLoc device (DePuy Mitek) was used in 3 studies, 8,31,39 a FasT-Fix device (Smith & Nephew) was used in 4 studies, 23,34,35,37 and Meniscus Arrows were used in 5 studies 22,30,36,40,42 (Table 1). Both first and second generations of the FasT-Fix device and Meniscus Arrow were utilized in the studies.…”

“…Although every study but one 42 reported overall sex ratios, only 2 studies 34,39 reported specific statistics for BHMTs. In these studies, women (31%; n = 40) had a failure rate of 25.7% and were significantly less likely to experience a failure than were men (69%; n = 90) ( P = .03), whose failure rate was 47.8% (Table 5, Figure 3).…”

Editorial Commentary: Moving the Needle: Traditional Inside-Out Meniscal Repair Has Advantages Over All-Inside Repair

“…In a study looking specifically at bucket handle meniscus repair, the repair construct did not affect outcomes; however, this study did demonstrate that the meniscus tear occurring in isolation increased failure rates. 6 This, along with other studies, shows that the biology at the time of meniscus repair is arguably more crucial than the structural aspect alone, with some mixed benefit of platelet-rich plasma and marrow venting. 7 How does this study affect my clinical care?…”

Factors associated with medial meniscal subluxation in knees with medial meniscus tears: a cross-sectional study

“…The types of MMT were categorized as horizontal tears, longitudinal tears, bucket-handle tears, radial tears, posterior medial meniscus root tears (PMMRT), and complex tears [17]. Because bucket-handle tears were de ned as a subgroup of longitudinal tears with an attached fragment displaced away from the periphery of the meniscus, we classi ed bucket-handle tears as longitudinal tears in this study [18,19]. The above data were collected as variates for analysis.…”