J Knee Surg 2018; 31(06): 514-519
DOI: 10.1055/s-0037-1604146
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Surgical Repair of Neglected Bucket-Handle Meniscal Tears Displaced into the Intercondylar Notch: Clinical and Radiological Results

Engin Cetinkaya
1   Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
,
Sarper Gursu
1   Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
,
Murat Gul
1   Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
,
Umit Selcuk Aykut
1   Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
,
Rasit Ozcafer
1   Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
› Author Affiliations
Further Information

Publication History

10 January 2017

31 May 2017

Publication Date:
18 July 2017 (online)

Abstract

The literature contains very limited articles wherein the treatment results of bucket-handle meniscal tears according to various types are evaluated and wherein results for repair of chronic tears are discussed. The objective of this study is a clinical and radiologic evaluation of arthroscopic repair for patients suffering flipped, neglected chronic bucket-handle meniscal tear in the intercondylar notch. A total of 26 patients were evaluated retrospectively. The mean age at the time of surgery was 27 years (range, 16–44). Mean period from meniscal injury to surgery was 28 months (range, 4–96). The mean follow-up period was 31 months (range, 11–67). During the follow-up, the patients were evaluated clinically, functional scores from the International Knee Documentation Committee (IKDC), Lysholm, and Tegner as well as magnetic resonance imaging (MRI). The mean preoperative Lysholm score of 24 increased to 85 postoperatively. Mean IKDC score was 56.3 preoperatively and 84.5 postoperatively. The mean Tegner score of 3.4 increased to 5.6 postoperatively. Mean Lysholm, IKDC, and Tegner scores in the first group were 84, 74, and 5.1, respectively, and in the anterior cruciate ligament (ACL) reconstruction group; 86, 85.9, and 5.8. While 20 (77%) out of 26 patients had none of the clinical findings, 6 patients (23%) presented with these findings. Postoperative MRI assessment revealed meniscal healing in 21 patients (27% complete, 54% partial healing) and no healing in 5 patients (19%). A clinical healing rate of 77% and a radiological healing rate of 81% along with statistically significant increases in Lysholm, IKDC, and Tegner scores prove that the repair option is effective for neglected, chronic bucket-handle meniscal tears flipping to the intercondylar notch. This study showed that good results could be achieved with the repair of neglected, chronic period bucket-handle meniscal tears flipping to the intercondylar notch, whether with an accompanying ACL tear or not.

Note

This study was conducted at Baltalimani Bone and Joint Diseases Education and Research Hospital, Istanbul, Turkey.


 
  • References

  • 1 Alford JW, Lewis P, Kang RW, Cole BJ. Rapid progression of chondral disease in the lateral compartment of the knee following meniscectomy. Arthroscopy 2005; 21 (12) 1505-1509
  • 2 Bonamo JJ, Kessler KJ, Noah J. Arthroscopic meniscectomy in patients over the age of 40. Am J Sports Med 1992; 20 (04) 422-428
  • 3 Petty CA, Lubowitz JH. Does arthroscopic partial meniscectomy result in knee osteoarthritis? A systematic review with a minimum of 8 years' follow-up. Arthroscopy 2011; 27 (03) 419-424
  • 4 Pujol N, Tardy N, Boisrenoult P, Beaufils P. Long-term outcomes of all-inside meniscal repair. Knee Surg Sports Traumatol Arthrosc 2015; 23 (01) 219-224
  • 5 Popescu D, Sastre S, Caballero M. , et al. Meniscal repair using the FasT-Fix device in patients with chronic meniscal lesions. Knee Surg Sports Traumatol Arthrosc 2010; 18 (04) 546-550
  • 6 Tengrootenhuysen M, Meermans G, Pittoors K, van Riet R, Victor J. Long-term outcome after meniscal repair. Knee Surg Sports Traumatol Arthrosc 2011; 19 (02) 236-241
  • 7 Espejo-Reina A, Serrano-Fernández JM, Martín-Castilla B, Estades-Rubio FJ, Briggs KK, Espejo-Baena A. Outcomes after repair of chronic bucket-handle tears of medial meniscus. Arthroscopy 2014; 30 (04) 492-496
  • 8 O'Shea JJ, Shelbourne KD. Repair of locked bucket-handle meniscal tears in knees with chronic anterior cruciate ligament deficiency. Am J Sports Med 2003; 31 (02) 216-220
  • 9 Shelbourne KD, Carr DR. Meniscal repair compared with meniscectomy for bucket-handle medial meniscal tears in anterior cruciate ligament-reconstructed knees. Am J Sports Med 2003; 31 (05) 718-723
  • 10 Phillips BB, Mihalko MJ. Arthroscopy of the lower extremity. In: Canale ST, Beaty JH. , eds. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, PA: Elsevier; 2013: 2393-2395
  • 11 Yoon JR, Muzaffar N, Kang JW, Lim HC, Bae JH, Nha KW. A novel technique for arthroscopic reduction and repair of a bucket-handle meniscal tear. Knee Surg Sports Traumatol Arthrosc 2009; 17 (11) 1332-1335
  • 12 Lim HC, Bae JH, Kim TS, Yang JH, Park SC, Yoon JR. Intra-articular patterns of bucket handle meniscal tears and its relation to reducibility. Clin Orthop Surg 2012; 4 (02) 129-133
  • 13 Miao Y, Yu JK, Ao YF, Zheng ZZ, Gong X, Leung KKM. Diagnostic values of 3 methods for evaluating meniscal healing status after meniscal repair: comparison among second-look arthroscopy, clinical assessment, and magnetic resonance imaging. Am J Sports Med 2011; 39 (04) 735-742
  • 14 Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 1982; 10 (03) 150-154
  • 15 Hefti F, Müller W, Jakob RP, Stäubli HU. Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1993; 1 (3-4): 226-234
  • 16 Tegner Y, Lysholm J. Rating systems in the evaluation of the knee ligament injuries. Clin Orthop Relat Res 1985; 198: 42-49
  • 17 Scott GA, Jolly BL, Henning CE. Combined posterior incision and arthroscopic intra-articular repair of the meniscus. An examination of factors affecting healing. J Bone Joint Surg Am 1986; 68 (06) 847-861
  • 18 Billante MJ, Diduch DR, Lunardini DJ, Treme GP, Miller MD, Hart JM. Meniscal repair using an all-inside, rapidly absorbing, tensionable device. Arthroscopy 2008; 24 (07) 779-785
  • 19 Kalliakmanis A, Zourntos S, Bousgas D, Nikolaou P. Comparison of arthroscopic meniscal repair results using 3 different meniscal repair devices in anterior cruciate ligament reconstruction patients. Arthroscopy 2008; 24 (07) 810-816
  • 20 Gill SS, Diduch DR. Outcomes after meniscal repair using the meniscus arrow in knees undergoing concurrent anterior cruciate ligament reconstruction. Arthroscopy 2002; 18 (06) 569-577
  • 21 Kotsovolos ES, Hantes ME, Mastrokalos DS, Lorbach O, Paessler HH. Results of all-inside meniscal repair with the FasT-Fix meniscal repair system. Arthroscopy 2006; 22 (01) 3-9
  • 22 Feng H, Hong L, Geng XS, Zhang H, Wang XS, Jiang XY. Second-look arthroscopic evaluation of bucket-handle meniscus tear repairs with anterior cruciate ligament reconstruction: 67 consecutive cases. Arthroscopy 2008; 24 (12) 1358-1366
  • 23 Eggli S, Wegmüller H, Kosina J, Huckell C, Jakob RP. Long-term results of arthroscopic meniscal repair. An analysis of isolated tears. Am J Sports Med 1995; 23 (06) 715-720
  • 24 Popescu D, Sastre S, Garcia AI, Tomas X, Reategui D, Caballero M. MR-arthrography assessment after repair of chronic meniscal tears. Knee Surg Sports Traumatol Arthrosc 2015; 23 (01) 171-177
  • 25 Jeong HJ, Lee SH, Ko CS. Meniscectomy. Knee Surg Relat Res 2012; 24 (03) 129-136
  • 26 Shelbourne KD, Dersam MD. Comparison of partial meniscectomy versus meniscus repair for bucket-handle lateral meniscus tears in anterior cruciate ligament reconstructed knees. Arthroscopy 2004; 20 (06) 581-585
  • 27 Melton JT, Murray JR, Karim A, Pandit H, Wandless F, Thomas NP. Meniscal repair in anterior cruciate ligament reconstruction: a long-term outcome study. Knee Surg Sports Traumatol Arthrosc 2011; 19 (10) 1729-1734
  • 28 Steenbrugge F, Verdonk R, Verstraete K. Long-term assessment of arthroscopic meniscus repair: a 13-year follow-up study. Knee 2002; 9 (03) 181-187
  • 29 Pujol N, Panarella L, Selmi TA, Neyret P, Fithian D, Beaufils P. Meniscal healing after meniscal repair: a CT arthrography assessment. Am J Sports Med 2008; 36 (08) 1489-1495