Meniscal bucket-handle tear

A bucket handle meniscus tear is a severe type of longitudinal tear in which the torn part of the meniscus detaches and rolls toward the center of the knee joint, resembling the handle of a bucket. This is a common knee injury caused by twisting trauma, resulting in severe pain and joint locking.

Patients typically present with knee pain and, more specifically, the "joint locking" sign, where the patient loses the ability to flex or extend the knee or cannot straighten the leg.

Diagnosing a bucket handle meniscus tear is not overly difficult, but intraoperative management is by no means easy. In the past, trimming the torn bucket handle meniscus was frequently performed, whereas nowadays, preservation repair methods are prioritized. As mentioned in previous articles, the meniscus acts like a "shock absorber" for the knee joint, and completely resecting the meniscus will lead to early knee osteoarthritis.

On the other hand, bucket handle tears often occur at the site where the meniscus attaches to the joint capsule, also known as the red-red zone, which has an abundant blood supply that supports a high healing rate for the meniscus.

Today, a 44-year-old male patient presented with a history of a right anterior cruciate ligament rupture sustained 7 years ago. About a month ago, the patient suffered another accident resulting in knee pain. Examination revealed knee laxity and pain in the medial compartment of the right knee. Magnetic resonance imaging showed a very clear sign of a bucket handle meniscus tear (Double PCL sign). The preoperative diagnosis was anterior cruciate ligament rupture and bucket handle tear of the medial meniscus, with the surgical plan to reconstruct the anterior cruciate ligament and repair the torn meniscus. Everything went as expected, and the surgery was a complete success.

Over my 13 years of practice, I have operated almost every day. You could say I am addicted to surgery. There are difficult cases and easy cases. Successfully performing a difficult case brings a quiet joy that lasts all day, whereas an unsatisfactory procedure ruins the appetite. Today, naturally, I am happy because I have saved yet another knee.