A bucket handle meniscus tear is a unique type of meniscus tear. Bucket handle meniscus tears are more common in younger athletes. They can occur in older adult athletes too, but most bucket handle meniscus tears occur in people under 35 years of age. A bucket handle tear is unique because the entire meniscus tears, flips over and becomes stuck in the middle of the knee joint.
It is essential to treat these tears early because they are very large tears. A bucket handle tear also “locks” the knee. That means that you are not able to fully straighten the knee. A bucket handle tear will usually not go back into its normal position on its own. It often needs our help. Let’s dive deeper.
The majority of these bucket tears can be fixed or sutured back together. In addition to being large, the torn part tends to flip over on itself and become stuck in the middle of the knee joint. If the meniscus flips over, you will find it painful to walk, and it can make it impossible to straighten your knee fully.
A meniscus is a c-shaped disc. We have two menisci within our knee, the medial and the lateral meniscus. A meniscus functions as a shock absorber. The meniscus serves a vital purpose by cushioning our knee when we walk, run, or play. If the meniscus tears, then that support or protection is lost, and osteoarthritis can occur.
What Is A Bucket Handle Meniscus Tear?
As you can see in the above picture, there are many different types of meniscus tears.
Bucket handle tears are most common in young athletes. The injury is usually non-contact and involves twisting or pivoting. Many athletes are injured in the same way.
They plant their leg to twist, pivot or change direction. They almost always feel a pop when the meniscus tears. Most patients with a large meniscus tear, such as a bucket handle or flap tear will develop significant swelling or bleeding in the knee joint.
The injury mechanism for a bucket handle meniscus tear is very similar to the injury mechanism which can create an ACL tear or a patella dislocation. When we see you in the office we are usually able to tell by our examination alone whether or not you have injured your meniscus, ACL or patella.
On examination in our office, we will not be able to straighten your knee, and you will have joint line tenderness. That means that you will have pain when we touch along the area where the meniscus usually attaches to.
When a bucket handle tear occurs, the meniscus supports, or the ligaments that hold the meniscus in place are torn. Without the support that keeps the meniscus in place, the meniscus can flop over like the handle on a bucket. When the meniscus flips over, it becomes stuck in the middle of the knee joint.
That results in a loss of motion because the meniscus is physically blocking you from fully straightening your knee. If you lose the ability to straighten the knee fully, then you have a “locked knee.” Many people with a locked knee are found to have a large piece of the meniscus which has flipped into the middle of the knee joint.
What Symptoms Does A Bucket Handle Meniscus Tear Cause?
Bucket handle tears of the meniscus tend to cause significant swelling and pain when they initially tear. After the initial swelling goes down, you will usually find that you can not straighten the knee. This is what we refer to as a locked knee.
That’s because the torn bucket handle meniscus tear is stuck in the center of the knee and is physically blocking the knee from straightening. Because of the loose piece of meniscus, you will notice a lot of popping, and you will have the sensation that something is stuck deep inside the knee. The knee feels very abnormal.
Many patients with a bucket handle meniscus tear will also complain that the knee feels loose or unstable. They will notice a lot of clunking or catching too.
How Do We Diagnose A Bucket Handle Tear?
A bucket handle tear is not a challenge to diagnose. Your story, as well as our physical examination, will usually raise our suspicion that a large meniscus tear exists. An MRI is usually necessary to confirm whether or not a complete meniscus tear is present. In addition, the MRI will show us if the meniscus is flipped over or if there is a large loose piece of meniscus stuck in the middle of the knee.
How Is A Bucket Handle Meniscus Tear Treated?
Most patients with a bucket handle meniscus tear will need to be treated surgically via an arthroscopy. During an arthroscopy, we put a small camera in the knee to see the meniscus tear.
Again, these tears are usually flipped over and stuck in the middle of the knee. The first thing we do is to push the meniscus back into its normal position. Then we look at the tear and see if it is repairable. Most bucket handle tears can be repaired by placing sutures or stitches in it.
A repair is strongly preferred over removal of the torn piece. We want to try and repair these tears. If we cannot fix it and we remove the bucket handle tear, you will be at high risk for developing osteoarthritis.
While many bucket handle tears can be repaired, others cannot be repaired. The decision of whether or not it can be fixed is made at the time of surgery when we are looking at the meniscus. If the meniscus has a good chance of healing, then we will proceed to repair it. If we do not believe that the meniscus will heal, then we need to remove the torn piece.
Recovery After A Bucket Handle Meniscus Tear
After surgery, you might be on crutches for a short while to protect the internal stitches and allow the meniscus to heal. After therapy and waiting enough time for the meniscus to heal, many athletes can enjoy a full return to activities after repair of a bucket handle tear. Return to sports after the repair of a bucket handle meniscus tear can take 4-6 months or more.
Can the meniscus tear again? Yes, it can. This is not common, but it does occur.
The majority of people who have a bucket handle tear will go on to lead a normal life if the tear is promptly treated, repaired and if the meniscus heals. Unfortunately, there is very little chance that non-surgical treatment will work for these large unstable tears. The timing of meniscus surgery is important too. A bucket handle tear should be fixed within a few weeks from the time the diagnosis is made. When the meniscus is flipped over, it is at risk of losing its normal shape and being torn more. If the meniscus loses its shape or tears more, then it may not be repairable.
Urmila M. says
I’m a moderately active 37 year old. Earlier this year (Jan) I hurt my right knee at the gym. I landed weird on the right foot when jumping off a box and my knee felt stiff. I saw an orthopedist a week later and by then I couldn’t even point where it hurt.
Fast forward to nine months later, and I hurt the same knee while playing tennis. I felt a ropy pop in my right knee and felt intense pain. I immediately iced it and got another appointment a week later. This time the knee still hurt and the doctor was able to pin point the area and immediately diagnosed a meniscus injury. Here’s the MRI report: TECHNIQUE: Routine MRI images of the right knee joint FINDINGS/CONCLUSION
1. Anterior compartment: Mild lateral patellar subluxation is present, with no patellar tilt. The patellar and trochlear cartilages appear normal. The patellar tendon is mildly elongated with relative high patellar position (mild patella alta).
2. Fluid collections: A moderate joint effusion distends the suprapatellar pouch. No popliteal cyst.
3. Ligaments/tendons: The anterior and posterior cruciate ligaments are intact. The medial collateral ligament and lateral collateral ligament complex are intact. The popliteus tendon and iliotibial band appear normal.
4. Medial meniscus: A complex, bucket-handle tear extends through the anterior horn, body, and posterior horn with a moderate inward displaced bucket-handle fragment which extends over the medial tibial spine.
5. Lateral meniscus: No tear is identified.
6. Osseous/articular: No arthropathy, osteochondral defect, stress injury, or osteonecrosis. No suspicious bone lesion.
It has been about a month since the injury and now I barely feel any pain. I am able to extend my knee fully and have been walking without a limp or any pain.
Can I leave the knee alone without any surgery?? Is there a chance my meniscus will heal on its own? I’ve started taking turmeric and collagen peptides in the hope that it will heal! Or is surgery the only fix? Any insight/advice will be much appreciated. I’m a mom of two active boys and I’d love to get back to my active lifestyle. Thanks!
Howard J. Luks, MD says
HI Urmila… It is unlikely that this type of tear heals on its own if it is displaced. That being said, obviously, some people have very little pain despite having a displaced bucket-handle meniscus tear.
Good luck to you.
Urmila M. says
Thanks, I might get the surgery after the recommended 3 weeks of PT. Surgery scares me. Particularly the pressure recovery may put on my family. And the fact that I may lose more meniscus and that may lead to early issues in that knee.
My 17 year old son had a bucket handle lateral tear from playing basketball. He had the surgery a few days later where it was repaired successfully. It has been 5 1/2 weeks now and he feels great. HE can fully extend his knee, run, etc. He wants to return to play basketball now for his high school team. Surgeon says it will be 4-6 months regardless. Is this normal protocol? If he feels 100% and wants to return in a few weeks is that reasonable? Are there specific tests which he can do to get cleared?
Thank you in advance!
Howard J. Luks, MD says
Your surgeon is correct. It takes many months for the meniscus to develop the strength it needs for a return to sports. Returning to sports too soon risks having a recurrent tear.
Lisa Bailey says
Hello. I felt a pop in my knee and then a strong painful pull up my thigh. I now cannot extend my leg out. It feels stuck and I have no pain sitting but a lot of pain walking.
I see the surgeon Monday morning but my question is this:
If my leg won’t straighten out how am I to get through an MRI? I can’t imagine being forced to straighten it when it doesn’t straighten.
Thank you for your time,
Howard J. Luks, MD says
Hi lisa… you can have the MRI with the knee partially bent.
Hi Doctor Luks,
I’m an active 48 yr old male. I had a bucket handle tear on the medial meniscus in 2017, and got by for 2 months with minimal discomfort before I saw s surgeon because the MRI showed a tear. He didn’t inform me I had a bucket handle tear at the time (though it was noted on the MRI I later found out) and scheduled me in for surgery telling me he’ll cut it out and ill be good to run around and do whatever sports I want after. After surgery he informed me he’d removed 60% of my meniscus and of course I never ran again but could walk, cycle and get by. I later asked why the meniscus wasn’t repaired and he said the meniscus has no blood supply and rarely do repairs last.
Fast forward 2 years and same surgeon recommended a microfracture surgery and guaranteed it’d get me back to better levels of activity. Naturally I agreed but this procedure wasn’t done due to advanced arthritis and articular cartilage loss and instead he did a debridement, shaving away more cartilage and meniscus. I would never of agreed to this was not the discussed procedure. I now have difficulty even walking, I cannot do my job and my quality of life has gone downhill.
I’ve just had stem cell treatment and hoping that provides some relief. In the near future I’m considering Osteotomy with cartilage regeneration and a meniscus transplant. In your professional opinion is this a good option?