This study reported the outcomes of locked bucket-handle medial meniscal tear (BHMMT) repairs using an arthroscopic posterior approach during anterior cruciate ligament (ACL) reconstruction.
Between 2011 and 2014, 48 patients with BHMMTs and ACL tears who met the eligibility criteria were enrolled in the present study. BHMMTs were assessed using a posterolateral transseptal portal and repaired using a posteromedial portal. Transportal ACL reconstruction was performed using hamstrings autograft. Patients were assessed based on their IKDC and Lysholm scores and Tegner activity level. Meniscal healing was clinically evaluated based on the absence of swelling, joint line tenderness, locking, and catching; McMurray test results; and the need for meniscectomy.
According to follow-up assessments, the average IKDC and Lysholm scores improved significantly after 3–5 years (P < 0.001)
Excellent clinical outcomes were obtained when locked BHMMTs were repaired using an all-inside suture technique that employed posteromedial and posterolateral transseptal portals.
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Ahn J-H, Ha CW (2000) Posterior trans-septal portal for arthroscopic surgery of the knee joint. Arthroscopy 16:774–779
Ahn JH, Kim K-I, Wang JH, Kyung BS, Seo MC, Lee SH (2015) Arthroscopic repair of bucket-handle tears of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc 23:205–210
Ahn JH, Kim S-H, Yoo JC, Wang JH (2004) All-inside suture technique using two posteromedial portals in a medial meniscus posterior horn tear. Arthroscopy 20:101–108
Alabi IA, Bancha C, Artha A, Kanokvaleewong C, Pena RJ (2020) Arthroscopic procedure for revision of failed isolated bucket-handle meniscal tear repair. J Orthop 21:350–369
Billières J, Pujol N (2019) Meniscal repair associated with a partial meniscectomy for treating complex horizontal cleavage tears in young patients may lead to excellent long-term outcomes. Knee Surg Sports Traumatol Arthrosc 27:343–348
Blanchard ER, Hadley CJ, Wicks ED, Emper W, Cohen SB (2020) Return to play after isolated meniscal repairs in athletes: a systematic review. Orthop J Sports Med 8:2325967120962093
Buyukdogan K, Laidlaw MS, Miller MD (2017) Meniscal ramp lesion repair by a trans-septal portal technique. Arthrosc Tech 6:e1379–e1386
Claret G, Montañana J, Rios J, Ruiz-Ibán M-Á, Popescu D, Núñez M et al (2016) The effect of percutaneous release of the medial collateral ligament in arthroscopic medial meniscectomy on functional outcome. Knee 23:251–255
Gaudiani MA, Knapik DM, Kaufman MW, Salata MJ, Voos JE, Karns MR (2020) Percutaneous superficial medial collateral ligament release outcomes during medial meniscal arthroscopy: a systematic review. Arthrosc Sports Med Rehabil 2:e153–e159
Han X, Wang P, Yu J, Wang X, Tan H (2020) Arthroscopic pie-crusting release of the posteromedial complex of the knee for surgical treatment of medial meniscus injury. BMC Musculoskelet Disord 21:1–9
Keyhani S, Ahn JH, Verdonk R, Soleymanha M, Abbasian M (2017) Arthroscopic all-inside ramp lesion repair using the posterolateral transseptal portal view. Knee Surg Sports Traumatol Arthrosc 5:454–458
Kim SH, Lee SH, Kim KI, Yang JW (2018) Diagnostic accuracy of sequential arthroscopic approach for ramp lesions of the posterior horn of the medial meniscus in anterior cruciate ligament-deficient knee. Arthroscopy 34:1582–1589
Kongmalai P, Chernchujit B (2016) Posterior horn of medial meniscal peripheral capsular lesion: the arthroscopic repair technique working in the posterior compartment. Arthrosc Tech 5:e763–e767
Lee WQ, Gan JZ, Lie DTT (2019) Save the meniscus: clinical outcomes of meniscectomy versus meniscal repair. J Orthop Surg (Hong Kong) 27:2309499019849813
Lubowitz JH, Rossi MJ, Baker BS, Guttmann D (2004) Arthroscopic visualization of the posterior compartments of the knee. Arthroscopy 20:675–680
Malinowski K, Góralczyk A, Hermanowicz K, LaPrade RF (2019) Tips and pearls for all-inside medial meniscus repair. Arthrosc Tech 8:e131–e139
Morgan CD (1991) The “all-inside” meniscus repair. Arthroscopy 7:120–125
Okazaki Y, Furumatsu T, Okazaki Y, Masuda S, Hiranaka T, Kodama Y et al (2020) Medial meniscus posterior root repair decreases posteromedial extrusion of the medial meniscus during knee flexion. Knee 27:132–139
Peltier A, Lording TD, Lustig S, Servien E, Maubisson L, Neyret P (2015) Posteromedial meniscal tears may be missed during anterior cruciate ligament reconstruction. Arthroscopy 31:691–698
Sonnery-Cottet B (2020) Editorial commentary: ramp lesion: the eye sees only what the mind is prepared to comprehend. Arthroscopy 36:2934–2937
Sonnery-Cottet B, Conteduca J, Thaunat M, Gunepin FX, Seil R (2014) Hidden lesions of the posterior horn of the medial meniscus: a systematic arthroscopic exploration of the concealed portion of the knee. Am J Sports Med 42:921–926
Tashiro Y, Mori T, Kawano T, Oniduka T, Arner JW, Fu FH et al (2020) Meniscal ramp lesions should be considered in anterior cruciate ligament-injured knees, especially with larger instability or longer delay before surgery. Knee Surg Sports Traumatol Arthrosc 28:3569–3575
Thaunat M, Fayard JM, Guimaraes TM, Jan N, Murphy CG, Sonnery-Cottet B (2016) Classification and surgical repair of ramp lesions of the medial meniscus. Arthrosc Tech 5:e871–e875
Thaunat M, Fournier G, O’Loughlin P, Kouevidjin BT, Clowez G, Borella M et al (2020) Clinical outcome and failure analysis of medial meniscus bucket-handle tear repair: a series of 96 patients with a minimum 2 year follow-up. Arch Orthop Trauma Surg 140:1649–1654
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All authors declared no conflict of interest.
The study protocol was reviewed and approved by the local Ethics Committee.
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Keyhani, S., Soleymanha, M., Verdonk, R. et al. Posterior knee arthroscopy facilitates the safe and effective all-inside repair of locked bucket-handle medial meniscal tear using a suture hook technique. Knee Surg Sports Traumatol Arthrosc (2021). https://doi.org/10.1007/s00167-021-06576-x
- Bucket-handle medial meniscal tears
- Posterolateral portal
- Posteromedial portal
- Transseptal portal
- Meniscal repair
- Medical meniscus