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.
Stephen
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
Austin
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?
Howard J. Luks, MD
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.
Blair
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.
Howard J. Luks, MD
Have they re-imaged your knee to see if the tear healed?
SHANNON KELLEHER
Hello Dr Luks,
Our son is 20 weeks post bucket handle repair, he is 16. We see surgeon this week, he is hoping to be released to full activity. 1 month ago he still had a fair amount of swelling, Dr told him to tap the breaks. His school trainer is very involved in his rehab. She reports his progression through video taping his run and various drills. I read you recommended a re-image, is this common or something we should discuss with Dr? He is a wide receiver and power forward, do you recommend a brace? He may have a little mental resistance? Please and thank you. This mom whats him to be ready to compete when his body is ready. The coaches and my husband seem to rushing his rehab…
Nathan
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?
Howard J. Luks, MD
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.
Lance W
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.
Howard J. Luks, MD
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.