Technique for All-Inside Repair of Bucket-Handle Meniscus Tears

Abstract

Bucket-handle meniscal tears (BHMT) remain a challenge to treat due to their complex pathology and technical difficulty. Subtotal meniscectomy has shown to improve symptoms early but leads to accelerated osteoarthritis in the affected compartment and poor long-term outcomes. BHMT repair and meniscal preservation is the preferred option. This can be performed with inside-out, all-inside, or hybrid meniscus repair techniques. All-inside meniscus repair avoids the need for additional safety incisions, trained assistants for suture passing, and reduce concerns of soft-tissue and neurovascular complications. In this Technical Note, we detail our all-inside technique for BHMT technique and share tips for a successful repair.

The “Under, Over” Technique for Repair of a Peripheral Bucket-Handle Meniscus Tear With Circumferential Compression Stitches

“…Yuen et al. 17 described the use of a traditional all-inside anchor-based technique for bucket-handle tears and minimized potential complications compared with inside-out techniques.…”

Outside in and all inside approach for repair of meniscal tears: post-operative subjective evaluation: a retrospective study

“…It is suggested that all-inside repair is quicker to perform than inside-out and that there is almost no risk of nerve entrapment, which can occur during tying of the inside-out or outside-in meniscus sutures. 10 Suturing methodologies applied in the management of meniscal tears Successful surgical meniscal repair despite surgical techniques depends on multiple factors, such as the healing process that is based on two basic principles: a solid primary fixation, and a biological process of cicatrization, which requires preceding abrasion. 11 Tears can be categorised into different categories based on healing probability and possible operative outcomes.…”

Meniscus tears and repair: assessing failure rates of all-inside and outside-in methods

“…Furthermore, the additional incisions required for suture tying in "inside-out" and "outside-in" meniscus repairs heighten the risk of wound infection. 11 As no consensus on the best approach to repairing meniscus tear has been made, researchers and practitioners are calling for the development of novel repair techniques and studies that compare the performance between different techniques so that evidence-based decisions on the optimal approach can be made. 9,12…”