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. These tears are unique because they are very large tears. 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 it can make it very painful to walk, and it can make it impossible to fully straighten your knee.
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 very important function 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?
These tears are most common in young athletes. The injury is usually non-contact and involves twisting or pivoting. You may have felt a pop when the meniscus tore. 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. A bucket handle meniscus tear is a unique type of tear. It represents a complete tear of the meniscus support or the ligament that holds the meniscus in place. Without the support that holds 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 fully straighten the knee then you have a “locked knee”. Many people with a locked knee are found to have a large piece of 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 simply 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 put the tear back into its normal position. Then we look at the tear and see if it is repairable. Most bucket handle tears are able to be repaired by placing sutures or stitches in it. A repair is preferred over a removal of the torn piece. We want to try and repair these, because if we do not repair it and we trim a bucket handle tear out, then you will lose a lot of your meniscus and you will be at high risk for developing osteoarthritis. While many bucket handle tears can be repaired, others can not be repaired. The decision whether or not it can be repaired 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 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.
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