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.
Martin Creel
Hello Dr. Luks and thank you for the great video and article. Your page has lifted some of the mystery of me knee pain.
I’m a 51 year-old male in good shape. My knee locked when I was a kid and I had surgery. A recent MRI revealed that most of the medial meniscus was removed (apparently this was just before arthroscopic surgery). My current surgeon recommended PT, strengthening the quads, which I have been doing consistently for six months. It has helped somewhat, but the knee still feels loose, clunks at the end of a full stride, and is painful if I walk more than two hundred yards. It’s much worse going downhill than uphill. I also have pain at night if I do not sleep with a pillow under my knee to support it. I’ve had no swelling. Recently the pain has intensified and radiated up and down the IT band with biking. My mobility is down considerably and I cannot seem to regain it. What are my options?
Trevor Mayfield
Hi Dr!
I am a 27 year old personal trainer with a lateral bucket tear. I don’t have much pain, only tightness in my lower quad, and occasional swelling there. I can do barbell squats and play soccer or whatever sport I’d like. But I do have some limitations in my mobility, mainly in my deep squat and kneeling sitting on my heels. I’m seeing some articles saying I’ll be fine, and some make me wonder about my later years. Should I get it removed?
Howard J. Luks, MD
We try very hard not to have to remove these large pieces of meniscus. That might contribute to the onset of arthritis. We prefer to fix them by suturing the pieces of the meniscus back together. I would gather a few opinions before moving forward with surgery.
Brandon
Hi,
I am concerned. I just got my bucket handle tear repaired. It’s been 7 days post-op and I still feel its impossible for me to walk or bare weight on it. Its crazy because i just came from my doctor and he said he is used to seeing other patients come in walking 2-3 days after their surgery. Discouraging to feel that my progress is slow. It just seems so far out of reach to even walk on my leg since ive lost muscle in it from being off of it for almost a month now. What do you think?
Best,
Brandon
Howard J. Luks, MD
Hard to say Brandon… Many people do recover quickly. Some recover much less rapidly.
Wish I could say more…
Cameron Watson
I had surgery 3 weeks ago for a MCL bucket tear. I can fully extend my knee when sleeping and currently walk on it. However when standing I still have a slight bend in the knee.. is this normal ? My doc said I shouldn’t rush it because it could potentially hyper extend.
Any info will help thanks.
Howard J. Luks, MD
HI Cameron… for many people it can take a while to get back full knee motion after a meniscus repair. Good luck
LG
I had a hiking injury in the 3rd of NOV, couldnot continue on the mountains and carried by helicopter . I did an MRI and the report is as below, when a first Dr. saw me, he wanted to operate right away and mentioned he will try to repair if he could not he will cut it. searched over the internet, that i can wait a bit and see how it will heal on itself and with PT I rested iced it and it is getting better, when I load it a bit it hurts so i reset again, i thought I am rushing it as i started walking, and doing stationary bike and some stretching with 7lbs of weights. Not sure I am doing the right thing , or I am blowing my chances forgetting it repaired if it could . All i honestly want is to heal or repair and avoiding survey that will risk cutting my meniscus as it is too early (39yr) for me and I love hiking alot. should I continue or look for alternative to surgery ( pbr, stem..etc) are those just for pain or help healing. Also, is the only option is cutting? if they cannot repair , why they do not leave it, my guessing cutting will make things worse on the future, non? I am working on my nutrition as well and eating food full of collegian , protein , vitamins and hydrating my self. Thanks to let me know the right path as i donot want to wait long or i lose my chances or any possible repair if any. Adding searching shows alternative surgery options are not everyone, would it be OK for me?
=====MRI Report=======================
ACL: intact
PCL: intact
Medial Meniscus: Intact
Lateral Meniscus: Bucket-handle tear of the lateral meniscus with displacement of the lateral meniscal body posterioly and extending into the intercondylar notch.
MCL:intact
Lateral collateral ligament complex : Lateral collateral ligament complex is intact. There is extenive increase T2 signal surrounding the lateral collateral ligment complex, reactive to the underlying lateral menisoal abnormality.
Joint: Large Joint efussion. Not malalignment
Soft Tissues: Mild edema is present suboutaneous soft tissue . No Baker’s Oyst. Moderate edema is present about the lateral knee. Moderate strain of the short head of the biceps femoris.
Osteochondral strcutures: No actue fracture or osteonecrosis. Partal-thickness cartilage loss medial patellar facet extending to the median patellar ridge. Cartilage signal is otherwise intact.
IMPRESSION:
Bucket-handle tear laterl meniscus
Mild patellofemoral compartment loss
Medial meniscus, cruciate and collateral ligaments are intact.
Moderaye strain of the biceps fermos muscle in the distal thigh
Large joint effusion
Howard J. Luks, MD
If the torn part is not displaced and if it returned into its normal position then there is a chance of it healing.
If the torn part is displaced, then it is very unlikely it will heal on its own.
The best chance of a repair is before the torn piece loses its shape and consistency or firmness.
Most complete bucket handle tears can be repaired, however, we do encounter some tears that are not repairable.
There are some of us who might consider a meniscus transplant (especially for a lateral meniscus) , if the torn piece needs to be removed and if the person develops lateral pain after removal.
Good luck
LG
Many thanks for reply. I just came from another Dr. he mentioned from the MRI he cannot tell if the meniscus is repairable or not. The only way he would tell is when I am in surgery and then I will not have a say and he will go and and trim it if needed. I understand , where he is coming from and if it is displaced, then it is displaced and it has to be restore to it original position anyhow. But why I cannot have a chance of repair, even if the cut is not near the blood vessels and see if the body will heal by itself. I do not mind the long wait after the surgery to give it time to heal or longer PT period. I guess saving the meniscus will benefit me on the long run. Can I send you the link for the MRI itself and if you think that this is a repairable or not, I would prefer that you operate on it. I live in VA and this should be a short fly. Basically, I do not want to leave any chances for trimming it if it can be saved. Thanks in advance
Howard J. Luks, MD
HI ..
My assistant can be reached at 914-789-2735.
You can send the link to her and we will see if we might be able to give you a better idea regarding repairability of the tear.