About the author:

Howard J. Luks, MD

A Board Certified Orthopedic Surgeon in Hawthorne, NY. Dr Luks specializes in the treatment of the shoulder, knee, elbow, and ankle. He has a very "social" patient centric approach and believes that the more you understand about your issue, the more informed your decisions will be. Ultimately your treatments and his recommendations will be based on proper communications, proper understanding, and shared decision making principles --- all geared to improve your quality of life. Please read our Disclaimer

43 comments on “Bucket Handle Meniscus Tear

  1. Great information. A recent MRI for me showed Degeneration and tear of the posterior horn of the
    medial meniscus. My was bothering me, but no great pain but It blew up with what felt like a pop during a golf swing and great pain. After an ER trip and orthopedic doctor visit here in NJ, I got the above MRI results. The pain has subsided, but I am leery of returning to my loved golf game.

    Thank You

    1. Such a common story — fear motivates many decisions. Fear plays an enormous role in the recovery from many injuries, surgically managed or non-surgically managed. Many of us feel that we are damaged once an MRI shows that something is “torn”. Yet .. that tear might have been there for years before your knee hurt. It’s obviously impossible to say for sure.

      Many people live long happy and active lives with degenerative meniscus tears, rotator cuff tears, etc. It takes a while for that fear to subside … but it usually does. Take it slow, give it time… unless your knee is locking or causing you to fall down there is no need to rush into anything — especially if any arthritic changes (chondral or cartilage thinning) is also noted on the MRI.

    1. There are many reasons why that might be the case. First, it depends on when the surgery was. Two, was it repaired or removed; three, was there arthritis found at the time of surgery? All of these will impact how long he may or may not have pain. Perhaps you might want to consider another opinion.

  2. HI Dr Luks! I am a 41yo female. Healthy at home mom, active to a fault… after 2 MRI my Dx is a bucket handle tear on Left Medial Bucket Handle Meniscus tear, with complete Severance of ACL. Both obviously require surgical treatment. But my question is is doing this at the same time the best option? They are saying a PBG is my best option for ACL repair and a surgical repair with 20% removal is the way to go for the Meniscus.. I’ve done some research but nothing really leaning one direction or the other as to these options being the best choice for long tear repair.. im reading that its kinda a dr preferance as to what they are most comfortable with.. and thats great but i want to be sure I have the best long term outcome.. i have kids and grand kids i need to play with support and my hubby and i love the outdoors hiking thoughts long walks beaches.. opinions suggestions… please any info helps. My second opinion basic gave the same RX as my first Dr.

    1. Yes.. both the ACL and the bucket handle can and should be fixed at the same time. Obviously a repair is favored over removal of the torn piece. Many bucket handle tears can be repaired, but others can not if they are degenerative.

      Good Luck !

  3. Dr Luks,

    This article and the above conversations have been very helpful. I have had my MRI show a meniscal bucket handle tear, though I feel fairly operable and am able to bicycle and hike with relatively low pain. Swelling is my main hindrance. As a 24 year old male, I am debating surgery either to repair or remove that part of the meniscus. Part of me wants to see how well I can recover without surgery. Is there any validity to trying this option? Or any harm in waiting for surgery down the line if I worsen? As an avid skier, 8 will be putting a lot of use into my knee.

    Thank you so much.

    1. Most true bucket handle tears can/should be repaired. If it is a true bucket handle and it was acute or due to an injury, there is a small chance it can heal on its own. I can’t offer advice on specific treatment plans. Good luck, I’m glad you found this thread useful.

  4. I’m 19 yrs old and I recently had my bucket handle tear of medial meniscus repaired and also my acl was replaced with hamstring muscle 3 months ago. Recently I started to walk without crutches and brace. And also due to the lack of bending my doctor suggested me for a knee manipulation and I agreed and now after it I’m fine now. But after my Complete rehabilitation is done can I go back to my previous activities like dancing and sports. Or there is any chance that again my meniscus tears after?

    1. Charan,
      Many people with ACL tears and bucket handle tears (assuming the tear heals) can return to an active lifestyle. The key is to fully complete your rehab and make sure you are working with physical therapists and athletic trainers who are very well versed in this area. Trying to return too soon will often result in a reinjury.

  5. I woke up and I couldn’t extend my knee. I went to the doctor and he said I had a meniscus tear. I got the MRI, but he only has me doing physical therapy. I asked him if I needed surgery and he said I was being dramatic. I’m confused

    1. Not all tears require surgery. PT can help many return to an active lifestyle. We consider surgery sooner rather than later if people have a loose piece of cartilage or a bucket handle tear which is stuck in the middle of the knee.

  6. Hi Dr. Luks,

    I had an injury playing soccer in January 2016, while kicking the ball I felt my knee snapped and a minute later my knee buckled hard and I went down. I had pain, swelling, my quad shrunk, and I couldn’t put my leg fully straight. After a couple of weeks I felt normal with a little problem having my leg fully straight. And a weird clicking noise is felt every time I do a squats in the outer part over my knee cap (feels like a piece of cartilage shift every time I squat down. No pain but I feel it).

    I am competitive power lifter and also compete in fitness shows. I started working out again slowly a couple of weeks after the injury, built up pretty quick and was lifting at my max within a couple of months (squatting, deadlift,etc). Around October 2016, I started feeling discomfort and minor swelling, and my knee started locking in, felt somewhat unstable, and pain was setting in just by being sitting down too long.

    On November 2016 I went to the Dr. and got an MRI, the diagnosed was:

    – A complete tear of the ACL.
    – A complex bucket-handle tear of the lateral meniscus with a large displace meniscal fragment seen in the intercondylar notch.
    – A vertical tear in the periphery of the posterior horn of the media meniscus.

    Decided to schedule surgery for December 29th, because I want to be able to lift without a problem and continue to compete. A couple of weeks ago, I woke up and my knee felt great, no pain, I can straighten it completely, I jogged for a while without a problem, and have been going to the gym to lift hard and felt great (however, the clicking is still there). Now I am a little hesitant to do the surgery since I feel great, but what I’ve read is that the bucket handle tear might have just got into place for a while and it might come back to hunt me if I don’t get it fixed. Is this accurate? Just wanted your point of view.

    Thanks.

    1. HI Jorge…
      Yes .. some bucket handle tears can reduce and then heal. Others might reduce but not heal. You need to have this conversation with your surgeon. It’s not an easy decision to make. Good Luck

  7. Hi Dr. Luk,
    I had a bucket handle meniscus repair and an acl reconstruction surgery August 2nd. I did physical therapy for 4 months and am still doing the exercises at home. After 5 months my knee is still swollen and alot of tightness all around below my knee cap. I can’t stand for long because my knee is not at the -10% and I can’t walk for long because my knee starts hurting. How long should it take for me to be able to walk close to normal. Thanks

  8. Hi Dr. luk,
    I have a bucket handle tear and when i didn’t know what i had i was able to squat 2 plates is that a normal?
    I’m having my surgery soon when do you think ill be able to return back to sports?
    thank you.

    1. Assuming the tear is repairable and sutured back into place many patients can start to return to the gym between 3-4 months after surgery.

  9. Hi – I had a ski accident and badly twisted my knee 4 weeks ago. I have a bucket handle tear:- this is the MRI report (translated from French)

    Integrity of the extensor apparatus.
    Thickening at the high insertion of the tibial collateral ligament and fibular control of elongation.
    There is an edema with a very inhomogeneous aspect of the tibial collateral ligament evoking a partial rupture.
    No solution of ligament continuity.
    Integrity of posterior cruciate ligament.
    Thickening and edematous rearrangement on the anterior cruciate ligament path in favor of elongation. No argument for a complete break.
    No signs of internal meniscal cracking.
    On the other hand, there is an external meniscal involvement with a “bucket handle” and somewhat subluxed appearance of the anterior horn of the external meniscus.
    Regularity of the surface of the cartilaginous femoro-tibial coating.
    The patella is at a satisfactory height.
    No patellofemoral chondropathy.
    Intra-articular effusion of great abundance supra-patellar and in the inter-condylar notch.
    No meniscal cyst

    Presence of a popliteal cyst extending over 35 mm in height.
    There is an important bone marking anomaly of contusional appearance of the external tibial plateau and to a lesser internal degree, visible in the form of a wide hyperintense T2 hypointense T1 range, inhomogeneous, poorly circumscribed.
    There is no visible fracture.
    Thickening and diffuse lymphoedematous remodeling of the subcutaneous fat around the knee, especially on the external side and at the level of the popliteal hollow.
    No collection.

    I am a very sporty 58 yr old and keen to be back dancing, hiking and skiing. I have been very diligent about my rehab and want to get back to as fit as possible and whilst my knee feels pretty stable and does not lock, I am not able to fully extend it compared to the other knee and it feels slightly bent all the time. I did not have much swelling and want to know if this is something which will improve with time and rehab or if surgery to repair the meniscus is the best option? Thank you

    1. Sorry… this is one of those situations where an examination is very important. I’m not a fan of reading about “elongation” of a ligament. Sometimes that means it was torn ?? That’s why an examination is so important here. Also, it bears mentioning. With an injury that severe, it is not unusual to still have stiffness and loss of motion.

      1. Thanks for getting back to me – I do still have stiffness and am pretty mobile. If I knew that I would regain full extension in time after rehab etc then that would be great. My question is that if the bucket handle tear will physically prevent this full extension and will not heal by itself – then would surgery (arthroscopy) not seem the logical solution to give me back full range of movement? Is there any difference between having the surgery sooner – or after 4 months for example. Thanks for any advice.

      2. A displaced bucket handle tear can prevent full extension. Whether or not surgery can improve your extension isn’t clear without me seeing you and your X-rays and MRI images.

      3. I had an arthroscopy 23rd March for my bucket handle meniscus repair and the surgeon also removed a very thin fibre tear from my ACL. Started physio 6th April and had second session yesterday. Thrilled to have my knee back in action – feels better every day and excited to be able to ski again next season! Surgeon and hospital were fantastic. The surgeon was highly recommended by the physio I was seeing beforehand as she said everyone that she saw post-op from this surgeon had an excellent outcome. ?

  10. Hi Dr. Luks,

    Thanks for your terrrifc site.

    I am a healthy 51 year old male who has been having moderate medial knee pain for the last year or so. I don’t recall any specific injury. I had an MRI (report below) and my orthopedic doctor recommends arthroscopic surgery. She said I have a bucket handle tear. However, my knee is strong (I do Bikram yoga 3x/week), I can extend my leg all the way, and though I can’t run well, walking is fine. I admit that it aches at times, but in general I’m against surgery unless it’s absolutely necessary. Just not sure what’s best here. Any advice?

    MRI RESULTS:
    1. Flap tear of medial meniscus, involving body and posterior horn
    2. Grade 2 chondral degeneration of the lateral aspect of the the medial patellar facet extending to the patellar ridge of a 1/2 cm area medial to lateral. Grade 2 chondral degeneration of the medial aspect lateral patellar facet extending over a 4.5 mm area medial to lateral.
    3. Mild proximal patellar tendinosis.
    4. Medial popiliteal cyst measuring up to 4.4 cm in longitudinal extent.
    5. Intact cruciate and collateral ligaments

  11. Hi Dr. Luks,
    Your site is very informative, thank you for posting so much information! I have had knee pain for 10 years (since running cross country and having some severe pain). My knee will act up after a lot of walking or exercising (I exercise regularly and am an otherwise healthy 26 year old woman). A recent MRI shows I have a complex bucket handle tear and I understand now that I can’t (and haven’t been able to for years) extend my knee fully because of this. My doctor wants to operate *immediately* to see if the tear (which is stuck in the middle of my knee) can still be repaired but he’s worried it has been separated for too long and will need to be removed. Is there truly an urgency in operating? Is it a concern to remove most of or the entire medial meniscus in one knee at this age?

    1. Losing a large piece of meniscus at your age would be a set up for osteoarthritis. The repairability of the tear does depend on how long it has been displaced. Once the meniscus is beaten up and changes its shape it is often not repairable. These are not emergent procedures…. but most of us do like to get these reduced and fixed soon after the injury to improve the chances of it healing.

  12. HI! I had a bucket handle tear repaired arthroscopically 10 months ago. I went through 6 months of physical therapy and finally released to be able to do physical activities after 7 months. I have been going to the gym doing cycling, elliptical and stair climbing exercises along with weights to increase my glute strength along with the rest of my body. Just recently I have been beginning to have increased discomfort and sometimes pain when on the elliptical or walking. Sometimes it feels like i have something small stuck or swollen causing the discomfort. I am unsure what to do now for this. Should i be resting my knee now? Continue Exercising? I did have the rooster shot about 6 months ago as well so maybe that is wearing off? This is becoming so frustrating! What about stem cell treatment? I have heard a few good things about that.

  13. Hi Howard,

    9 days ago I went to emergency due to a locked knee and a bucket handle tear. Since then I have been on crutches and cannot see a specialist until a few more weeks. I am just wondering how long my knee could possibly be locked for? Can and will it unlock on its own or will I be on crutches waiting for surgery?

    1. It might stay locked, or the tear might reduce and unlock. IT’s hard to say. It’s wise to stay on crutches to avoid further damage to the damaging the meniscus and knee.

  14. Hi Dr. Luks – My orthopedic surgeon just informed me I have a bucket handle tear in my lateral meniscus. I previously had a bucket handle torn meniscus in the same spot but it was arthroscopically repaired 7 years ago. This time, I was just kneeling down and somehow I re-tore the meniscus. There was no swelling. However, my knee would lock and it was painful to straighten my knee. My orthopedic surgeon is suggesting surgery to remove 50% of my meniscus. I am only 32 years old and I am worried this surgery will cause early osteoarthritis. I am considering a meniscus allograph or stem cell therapy to avoid osteoarthritis. What’s your opinion on meniscus allographs and stem cell therapy for a bucket handle tear? I am also wary of meniscus allographs and stem cell therapy because they are fairly untested. I will receive electronic copies of my MRI tomorrow and can upload them if necessary.

    1. Meniscus transplants are an option to consider in circumstances where you lose a considerable portion of your meniscus. Just be sure to find someone who performs many and is comfortable with doing them.

  15. Hi two weeks ago I jumped up from a low squat and heard a tearing sound and immediate pain ensued. I visited the a and e department and discharged with pain relief. The following day my knee was horribly swollen and I can not weight bear or straighten my knee… The swelling is still present 2 and a half weeks later and I underwent an mri yesterday and the results are showing a bucket handle tear of the lateral meniscus with meniscus fragment lying in the intercondylar notch lateral to the anterior crucial element ligament…. Will I need surgery?? Please advise and thank you …. Great site

    1. Thanks for the kind words Caroline… it’s possible that you will need surgery. Unless the tear goes back into place on its own.

  16. Im a 53 yrs of age. A couple months ago I twisted/strained my left knee. MRI results indicated the following; bucket handle tear involving the posterior horn of medial meniscus. Displacement of meniscal fragment was noted medially in the intercondylar notch anterior to the ACL.Diffuse loss of articular cartilage in medial tibiofemoral compartment with moderate subcortical marrow endema and cyst formation. Severe chondrosis, mild patellar bursitis.I had arthroscopic and ACL graft (currently intact) 30 years ago. The orthopedic surgeon doesn’t quite readily see the tear. Although not discounting that one may exist and suggests big arthritis no surgery(arthroscopic} but physio at this time. Is it possible for the bone guy and radiologist to see different things?

    1. Sometimes we disagree… but your Ortho should be able to put the findings into context. When the OA is moderate to severe it is not unusual for us to “ignore” the meniscus tear since we can not treat OA arthroscopically. Most of us will not consider an arthroscopy if the meniscus tear is in the presence of moderate severe OA.

      1. I now understand where my Ortho was coming from. Your response was very clear and concise and also greatly appreciated.Thanks for clearing the fog!

  17. Really interesting read. I had a bucket handle tear of the lateral meniscus in April. I had an operation to repair in May and I’m still in a leg brace & on crutches. It was a ‘red on white’ tear which I got from a trauma injury (I’m 29 so not degenerative)

    I had my leg brace set up to a 90 degree bend this morning however when I get to about 70 degrees it’s very painful, in the back of the knee but also a sharper pain across the front of the knee cap. I haven’t yet bent it further.

    Should i be worried about the sharper knee pain? I’ve been warned there is a chance the surgery won’t be successful if the cartilage doesn’t heal.

    Thanks

    1. Many surgeons have their own rehabilitation regimens. Some progress patients slower than others. If the knee is painful it might be because of the stiffness. It could be because of the tear too. I can not tell which it might be, nor can I offer specific treatment advice. YOu could seek another opinion if you are concerned.
      Good luck

  18. Hello – I’m so impressed with your willingness to respond to questions online. It’s been helpful to read through these responses. My MRI report shows I have a right medial meniscus tear with a displaced fragment. Not sure what this means. It says it’s a “…displaced medial meniscus fragment contiguous with the posterior horn near the posterior root. The fragment lies along the intercondylar notch…the posterior horn appears truncated along its free edge and abnormally small in volume near the posterior root. The lateral meniscus appears normal. There appears to be irregular full-thickness chondral loss along the weight bearing surfaces of the medial compartment. Some chronic chondral loss at the patella….” Anyway – I’m hoping this is something that can be treated with physical therapy. Curious about your thoughts on this. In particular, what is a displaced fragment – does that mean it’s still attached, but has just pulled away. Or is it detached? I appreciate any comment you might have.

    1. I displaced fragment usually refers to a piece that tore loose from the front of the meniscus but remains attached in the back of the knee. You also have degenerative changes (arthritic changes) (irregular full thickness cartilage loss) so that should temper the enthusiasm to consider arthroscopy to manage this. Trying PT first is rarely a bad idea….

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