Summary
The rate of incomplete healing after arthroscopic repair of bucket handle tear was significantly higher at the medial meniscus than at the lateral meniscus, but there was no difference in clinical failure between bucket handle medial meniscus tear and lateral meniscus tear.
Abstract
Background
Since bucket-handle tears are usually larger and displaced, their repair can be challenging. There have been few comparative studies evaluating clinical and radiological outcomes of bucket-handle meniscal tears.
Purpose
This study aimed to assess the clinical outcomes, failure rate, and risk factors for failure of bucket-handle tears that were treated with arthroscopic repairs.
Methods
Seventy-four cases of bucket-handle tears (mean age, 27.2 ± 11.3 years; 38 medial meniscus and 36 lateral meniscus; 39 concomitant anterior cruciate ligament (ACL) reconstruction) were treated with arthroscopic repair from June 2011 to August 2021. The exclusion criteria were revisions, fracture histories, combined with microfracture and root repair. Chi-square test, Fisher exact test, Mann-Whitney test analysis and multivariable Cox proportional hazard ratio model were performed to evaluate the factors. These factors were: age, sex, body mass index (BMI, = 25kg/m2), chronicity (= 6 months), laterality (medial meniscus or lateral meniscus), and location (posterior horn only, tear involving midbody). They also comprised: tear zone (red-red zone only, involving red-white zone), number of stitches for repair, use of meniscal fixator device and concomitant ACL reconstruction. All cases underwent clinical follow-up at a minimum of one year (average follow-up: 32.42 months [range, 12–106.6]). The clinical results were evaluated based on Tegner score, Lysholm knee score and Hospital for Special Surgery (HSS) score by Wilcoxon signed-rank test. The radiologic analyses of arthroscopic repair were interpreted as complete, incomplete, and re-tear on postoperative magnetic resonance imaging (MRI) scans with 66 cases.
Results
Of all 74 cases of bucket-handle tears undergoing arthroscopic repair, the failure rate was 16.2%, which was re-tear state on postoperative MRI or at second-look arthroscopy. BMI (Hazard Ratio, 4.69 [95% CI: 1.38–15.92]) and involving red-white zone (Hazard Ratio, 4.75 [95% CI: 1.03–21.92]) were significant factors associated with bucket-handle tears (P <0.05). Comparing between preoperative and postoperative states, the Tegner score (from 2.38 ± 1.22 to 4.11 ± 1.30), Lysholm knee score (from 69.01 ± 10.40 to 87.37 ± 6.35), HSS score (from 79.67 ± 9.64 to 93.63 ± 4.80) were statistically significantly different (P <0.05). The laterality and concomitant ACL reconstruction did not clinically influence failure of repair. However, bucket-handle medial meniscus tears treated with arthroscopic repair showed statistically high predisposition to incomplete healing on postoperative MRI (average: 10.36 months [range, 5.0–73.7]).
Conclusion
The BMI and tear involving red-white zone affected failure of arthroscopic meniscus repair of bucket-handle tear. The ratio of complete healing state after arthroscopic repair of bucket-handle tear was statistically higher at the lateral meniscus than at the medial meniscus. However, there was no clinical difference in failure between laterality and concomitant ACL reconstruction.