Study on clinical characteristics and surgical methods of bucket-handle meniscal tears / 中国修复重建外科杂志

OBJECTIVE@#To summarize the clinical features, surgical methods, and prognosis of bucket-handle meniscal tears (BHMTs), and provide guidance for clinical treatment.@*METHODS@#The clinical data of 91 BHMTs patients (91 knees), who met the selection criteria and were admitted between January 2015 and January 2021, was retrospectively analyzed. There were 68 males and 23 females. Age ranged from 16 to 58 years with an average of 34.4 years. The injury was caused by sports in 68 cases, traffic accident in 15 cases, and falls or sprains in 8 cases. There were 49 cases of left knee injury and 42 cases of right knee injury. The time from the onset of symptoms to the admission ranged from 1 day to 13 months (median, 18 days), including >1 month in 35 cases and ≤1 month in 56 cases. Medial BHMTs occurred in 52 cases and lateral BHMTs in 39 cases. There were 36 cases with ACL rupture and 12 cases with discoid meniscus. The knee extension was limited more than 10° in 55 cases. According to the condition of meniscus injury, the meniscus suture with Inside-out combined with All-inside techniques (54 cases) or meniscoplasty (37 cases) under arthroscopy were selected. ACL reconstruction was performed in all patients with ACL rupture with autogenous hamstring tendon. Postoperative complications were observed. International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner score were used to evaluate knee function, and clinical failure was recorded.@*RESULTS@#Two patients developed intermuscular venous thrombosis, which improved after oral anticoagulant therapy. No vascular injury, postoperative infection, joint stiffness, or other complications occurred in all patients. All patients were followed up 24-95 months, with a median of 64 months. A total of 12 cases (13.19%) failed the operation and were re-operated or given oral anti-inflammatory analgesics and rehabilitation therapy. At last follow-up, IKDC score and Lysholm score of 91 patients significantly increased when compared with those before operation ( P<0.05), while Tegner score significantly decreased ( P<0.05). The above indexes of patients treated with meniscus suture and meniscoplasty were also significantly different from those before operation ( P<0.05).@*CONCLUSION@#BHMTs occurs mostly in young men and is one of the important reasons for the limitation of knee extension after trauma. Arthroscopic meniscus suture and meniscoplasty can obtain good effectiveness according to individual conditions of patients. But the latter can better preserve the shape and function of meniscus, and theoretically can obtain better long-term outcomes, which needs to be confirmed by further research with larger sample size.

Intra-articular Patterns of Bucket Handle Meniscal Tears and Its Relation to Reducibility

BACKGROUND: The purpose of this study was to assess the intra-articular patterns in the rotational deformities of bucket handle meniscal tears (BHMTs) based on arthroscopic findings and their clinical relevance. METHODS: From 2004 to 2009, 42 patients with a BHMT diagnosed by magnetic resonance imaging underwent arthroscopic surgery. The arthroscopic data (all procedures were recorded) were evaluated retrospectively, and BHMTs were classified according to the rotational directions of centrally displaced fragments. To assess the reliability of the agreement in this classification, 2 orthopedic surgeons re-classified BHMTs, 1 week after first trial. Intra- and interobserver reliabilities were assessed using kappa statistics. In addition, we address specific tear patterns, associated anterior cruciate ligament injury, medio-lateral difference, reducibility, chronicity, and reparability. RESULTS: Most of the tears could be categorized into one of 3 morphologic patterns. Of the tears, 4.8% could not be categorized. BHMTs were classified, based on the rotational directions of centrally displaced fragments, as follows; the upward rotation group (type 1), the downward rotation group (type 2) and the reverse group (type 3). The most common intra-articular pattern was type 1 (29 patients, 69%). The occurrence of the other patterns was: type 2 in 7 patients (16.7%), type 3 in 4 patients (9.5%); we were not able to make a classification of type in 2 patients (4.8%). Intra-observer reliability was 0.86 in terms of kappa statistics, which implies almost perfect agreement. Mean interobserver reliability (0.73) showed substantial agreement. Type 1 and 2 tears were easily reduced, whereas all type 3 tears (4/4) needed additional procedures to achieve reduction. CONCLUSIONS: Based on arthroscopic findings, we describe a comprehensive BHMT classification scheme that encompasses 95.2% of all tears. Tear type was correlated with reducibility.

Ananalysis of the Clinical and MRI Findings of the Bucket: Handle Meniscal Tears of the Knee Joint / 대한정형외과학회잡지

Recently MRI has been shown to be a sensitive and specific study for the noninvasive detection of meniscal tears and several MRI findings of bucket-handle meniscal tears have been reported. Therefore, the MRI findings of the menisci proven to be the bucket-handle tear with arthroscopy were evaluated and the typical MRI findings seen to be the bucket-handle meniscal tear of the knee were analysed. 76 patients with proven bucket-handle meniscal tears arthroscopically were reviewed retrospectively, in which MRI was performed in 24 patients. The 3 typical findings of bucket-handle meniscal tears were assessed: double PCL (posterior cruciate ligament) sign, flipped meniscus sign, and fragment in the intercondylar notch. In 245 cases of meniscus tears, bucket-handle meniscal tears were 76 cases (31.0%) with 52 cases at medial meniscus and 24 cases at lateral meniscus. As to clinical and physical findings of the bucket-handle meniscal tears, McMurray test, locking, joint line tenderness and giving way sense were presented in orders. The sites of bucket-handle meniscal tear were medial meniscus in 17 cases and lateral in 7 cases. The double PCL sign was seen in 10 cases (58.8%) of in medial bucket-handle meniscal tears and in 3 cases (42.9%) of 7 lateral bucket-handle meniscal tears. The flipped meniscus sign were seen in 3 cases (17.6%) of medial bucket-handle meniscal tears and in 3 cases (42.9 %) of lateral bucket-handle meniscal tears. Fragments were identified in the intercondylar notch in 8 cases (47.1%) of medial bucket-handle meniscal tears and in 3 cases (42.9%) of lateral bucket-handle meniscal tears. There were 19 cases (79.2%) in which at least one or more typical findings were presented on MR images. The MRI is a sensitive study for detection of bucket-handle meniscal tears but precise interpretation of MRI is needed for diagnosis of bucket-handle tears. In this respect, the above three typical findings are helpful and reproducible for diagnosis of bucket-handle meniscal tears with MR images; double PCL sign, fragment in the intercondylar notch and flipped meniscus sign.