Summary

The objective and subjective results of the present study indicate that arthroscopic repair using a hybrid technique with all-inside and outside-in sutures is a safe and valid option for the treatment of patients with large posterior horn and pars intermedia bucket handle tears at an acceptable failure rate (11%).

Abstract

Purpose

Meniscal tears are among the most common indications for orthopedic surgical intervention with bucket-handle tears accounting for large and serious lesions. The purpose of this study was to evaluate clinical outcomes, failure rate, and patient satisfaction after arthroscopic repair of large posterior horn and pars intermedia bucket handle tears to assess the viability of this approach as an alternative to meniscectomy. Our hypothesis was that arthroscopic meniscal repair using both all-inside and outside-in sutures would be able to significantly improve outcome measures without incurring unacceptable failure rates even with large bucket-handle tears.

Methods

This study constitutes a retrospective single-surgeon clinical follow-up study (level of evidence IV). We retrospectively identified 106 consecutive patients who underwent arthroscopic repair of large posterior horn and pars intermedia bucket handle tears between 2008 and 2020 and matched the eligibility criteria. Pre- and postoperative values for International Knee Documentation Committee (IKDC) subjective scores, Lysholm scores, Knee Injury and Osteoarthritis Outcome Scores (KOOS), Tegner activity scale, and visual analog scale for patient satisfaction were obtained using standardized questionnaires. The IKDC subjective score was the primary outcome measure and a p value < 0.05 was considered significant. Arithmetic mean and standard deviation were calculated for complete datasets. Pre- and postoperative values were compared with paired t tests.

Results

At the time of writing, data were available from 54 patients (33 male, 21 female), including 10 lateral and 42 medial posterior horn and pars intermedia bucket handle tears (two patients had tears of both menisci). The mean age was 30 ± 14.4 years. Tears were located in the red-red zone in 94% of patients and 68.5% of tears were dislocated into the femoral intercondylar notch. The mean number of total sutures used was 11 ± 3.2 (all-inside and outside-in). The mean follow-up was 86.5 ± 41.3 months with a minimum follow-up of two years. All postoperative clinical outcome measures showed statistically significant improvements compared to preoperative values. IKDC subjective scores improved from 37.4 ± 23.6 to 81.4 ± 16.9 (p < 0.001). Lysholm scores improved from 43.5 ± 30.1 to 87.7 ± 15.9 (p < 0.001). Visual analog scale for patient satisfaction improved from 2.7 ± 2.7 to 7.6 ± 2.8 (p < 0.001). All KOOS subcategories, KOOS total, and Tegner activity scale showed statistically significant improvements as well (p = 0.011). The failure rate was 11% at final follow-up.

Conclusions

Patients undergoing arthroscopic repair of large meniscus bucket handle tears showed significantly improved clinical outcome measures and patient satisfaction with an acceptable failure rate (11%) at 2 to 10 years follow up. These results support the hypothesis that arthroscopic repair is viable even in large posterior horn and pars intermedia bucket handle tears using a hybrid technique with all-inside and outside-in sutures. The procedure was able to improve function, reduce symptoms, and increase patient satisfaction and should therefore be considered when treating large bucket-handle tears.