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.
Caroline
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
Howard J. Luks, MD
Thanks for the kind words Caroline… it’s possible that you will need surgery. Unless the tear goes back into place on its own.
Caroline
Thank you for your time and response and I appreciate you are a busy chap and will let you know the outcome of the ortho
Tim Lidstone
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?
Howard J. Luks, MD
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.
Tim Lidstone
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!
Alexandra Croft
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
Howard J. Luks, MD
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
Kathy
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.
Howard J. Luks, MD
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….
Kala
Hello, I’m and 29yo female and twisted my knee 3 weeks ago. After a quick exam at a patient first I was told I had a fracture then the radiologist said there was no evidence of fracture. I then saw an orthopedic who said I dislocated my patella. Finally, I had an MRI with findings of a bucket handle tear of the medial meniscus. I have a follow-up appointment on Monday with the doctor. I am concerned after reading that since it has already been 4 weeks and I have been walking on it for 3 now that it may not be repairable. Do you think it has been too long? I am worried it will need to be cut out which I read is not good especially at my age. Thanks!
Howard J. Luks, MD
Most bucket handle tears are still repairable at 4-6 weeks after the injury.