Clinical observation of arthroscopic all-inside combined with outside-in "suture loop" repair for meniscus bucket-handle tear / 中国修复重建外科杂志

Objective: To investigate the effectiveness of arthroscopic all-inside combined with outside-in "suture loop" repair for meniscus bucket-handle tear (BHT). Methods: Between August 2016 and May 2019, 44 case of meniscus BHT were treated with arthroscopic all-inside combined outside-in "suture loop". There were 29 males and 15 females with an average age of 26.6 years (range, 18-42 years). The causes of injury included sports injury in 31 cases, falling injury in 7 cases, and sprain in 6 cases. There were 32 cases of medial meniscus posterior horn tears and 12 cases of lateral meniscus posterior horn tears. The disease duration ranged from 6 weeks to 3 months. Thirty-three cases were complicated with anterior cruciate ligament rupture. All patients had normal lower limb alignment. The preoperative Lysholm score was 42.1±9.1. According to the evaluation criteria of MRI and Barrett et al., the healing of meniscus was evaluated, and the effectiveness was evaluated by Lysholm score. Results: All the 44 patients were followed up 8-36 months with an average of 16.8 months. At last follow-up, according to the evaluation criteria of Barrett et al., 39 cases were clinically healed, 5 cases were not healed, the clinical healing rate was 88.6%; according to MRI evaluation, 32 cases were completely healed, 7 cases were partially healed, and 5 cases were not healed, the total healing rate was 88.6%, and the complete healing rate was 72.7%. Lysholm score was 87.8±4.8, which was significantly different from that before operation ( t=31.060, P=0.000). Conclusion: Arthroscopic all-inside combined with outside-in "suture loop" repair is a reliable and effective method for the meniscus BHT, which can obtain good joint function.

Displaced Double-Layered Lateral Meniscus That Mimicked the Bucket-Handle Tear: a Case Report

Among the various types of congenital meniscal anomalies, the double-layered lateral meniscus is extremely rare. The double-layered meniscus consists of both the upper additional and the lower normal meniscus. As the upper additional meniscus is mobile, it can be easily displaced, while the lower lateral meniscus is usually normal in shape and volume. A 42-year-old woman suffering from pain and locking of her left knee underwent Magnetic resonance imaging (MRI) examination and an arthroscopic surgery. A rare meniscal abnormality was seen in her left knee, which presented as a double-layered lateral meniscus with displacement. It was remarkable that the upper additional meniscus was displaced over the intercondylar eminence of the tibia and it mimicked a bucket-handle tear. Even though it is rare, it is necessary to consider the possibility of displaced double-layered meniscus in the differential diagnosis of a bucket-handle tear. Here, we report the MRI and arthroscopic findings of a displaced double-layered lateral meniscus, which was similar to the bucket-handle tear.

Spontaneous Healing of a Displaced Bucket-Handle Tear of the Lateral Meniscus in a Child

Bucket-handle tears less frequently occur in the lateral meniscus than in the medial meniscus. An 11-year-old male patient complained of painful swelling and locking due to a displaced bucket-handle tear of the lateral meniscus. We recommended an arthroscopic surgery; however, the patient left the hospital without surgical treatment. Six weeks afterwards, he returned without any complain of pain and he regained full range of motion. The final follow-up magnetic resonance imaging showed reduction of the torn meniscal fragment without any signal changes suggestive of a meniscal tear. We report a rare case of an isolated displaced bucket-handle tear of the lateral meniscus in an 11-year-old patient that healed spontaneously without surgical intervention.

Posterior Double PCL Sign; A Case Report of Unusual MRI Finding of Bucket-handle Tear of Medial Meniscus: A Case Report / 대한정형외과학회잡지

Among the MRI signs of meniscal bucket handle tears, a double posterior cruciate ligament (PCL) sign manifests on the sagittal images as a low signal band anterior and parallel to the PCL. The mesially displaced fragment may be confined to the intercondylar notch. However, the torn fragment is rarely displaced to the posterosuperior region of the PCL. If it does occur, separation at the anterior horn may be assumed. We propose this type of lesion be called the posterior double PCL sign in contrast to the ordinary double PCL sign. We present a case showing the 'posterior double PCL sign' accompanying an anterior cruciate ligament injury.

Arthroscopic Meniscectomy in Bucket Handle Tear of the Meniscus / 대한정형외과학회잡지

Recently, the frequency of meniscal injury of knee has been increasing due to increase of sports activities. It has been known that bucket handle tear is the most common type of the entire injuries of the meniscus. We found 127 cases of meniscal tears and experienced 42 cases of bucket handle tears in the arthroscopic findings from Jan. 1991 to April 1994 in our hospital. We analysed 31 cases which were followed up for at least 1 year. The purpose of this study is to analyse the locking history and frequency, to discuss the several types of bucket handle tear in arthroscopic view, to introduce three portal techniques using posteormedial or posterolateral portal to resect the meniscus, and to analyse our clinical results. So we concluded as follows. 1. Among the 31 cases, 23 cases(74%) had an episode of locking. 2. We found many different types of bucket handle tears in arthroscopic view and the most common type was complete tear in a classic type(11 cases). 3. We were able to resect the meniscal fragment very easily using posteromedial or posterolateral portal. 4. We obtained satisfactory results in 24 cases(77%).