Skip to main content
SpringerLink
Log in

What are the factors to affect outcome and healing of meniscus bucket handle tears?

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The purpose of this study is to identify patient, meniscus rupture and surgical characteristics that influence the outcome and clinical healing following operative repair of bucket handle tears.

Methods

Between 02/2006 and 10/2012, a total of 38 patients (14 women, 24 men) with bucket handle tears underwent surgical meniscus repair. There were 27 isolated repairs and 11 with concomitant anterior cruciate ligament (ACL) replacement. Patients were analyzed on an average of 44.4 months (range 15–96 months) after surgery by the use of standardized subjective scoring instruments [Lysholm, International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Tegner Activity Scale (TAS)]. To identify factors affecting the outcome and suture survival, patient-specific, trauma-specific as well as meniscus- and surgery-specific factors were collected. Patients were divided in two groups with healed menisci (group 1) and re-rupture subjects (group 2). Meniscus re-rupture was defined as a clinical failure.

Results

There were 25 patients with healed menisci and 13 (34.2%) that sustained re-rupture and underwent either partial meniscectomy (n = 8) or re-suture (n = 5). Group 1 achieved slightly higher outcome compared to group 2 [Lysholm: 87.8 vs. 84.3 (p = 0.35), IKDC: 86.9 vs. 85.7 (p = 0.67), KOOS: 91.3 vs. 90.5 (p = 0.74)]. TAS was better for group 2 [5.9 vs. 6.8 (p = 0.36)]. Strong impact to result in a significantly increased outcome was identified for higher age, subjective knee joint stability, high preoperative Lysholm Score, short trauma-to-repair time, previous ACL reconstruction and a smaller number of sutures to fulfill meniscus repair. Lower patient age, male gender and higher activity level had the strongest impact to provoke re-rupture.

Conclusion

Clinical outcome after meniscus bucket handle suture is satisfying. Re-rupture rate among this collective was 34.2%. Clear risk factors were identified for diminished clinical healing and outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Abrams GD, Frank RM, Gupta AK, Harris JD, McCormick FM, Cole BJ (2013) Trends in meniscus repair and meniscectomy in the United States, 2005–2011. Am J Sports Med 41(10):2333–2339. https://doi.org/10.1177/0363546513495641

    Article  PubMed  Google Scholar 

  2. Ahn JH, Kim K-I, Wang JH, Kyung BS, Seo MC, Lee SH (2013) Arthroscopic repair of bucket-handle tears of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-013-2764-9

    Article  PubMed  Google Scholar 

  3. Allen CR, Wong EK, Livesay GA, Sakane M, Fu FH, Woo SL (2000) Importance of the medial meniscus in the anterior cruciate ligament-deficient knee. J Orthop Res Off Publ Orthop Res Soc 18(1):109–115. https://doi.org/10.1002/jor.1100180116

    Article  CAS  Google Scholar 

  4. Aydingöz U, Firat AK, Atay OA, Doral MN (2003) MR imaging of meniscal bucket-handle tears: a review of signs and their relation to arthroscopic classification. Eur Radiol 13(3):618–625. https://doi.org/10.1007/s00330-002-1618-5

    Article  PubMed  Google Scholar 

  5. Bach BR, Dennis M, Balin J, Hayden J (2005) Arthroscopic meniscal repair: analysis of treatment failures. J Knee Surg 18(4):278–284

    Article  PubMed  Google Scholar 

  6. Beaufils P, Becker R, Verdonk R, Aagaard H, Karlsson J (2015) Focusing on results after meniscus surgery. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 23(1):3–7. https://doi.org/10.1007/s00167-014-3471-x

    Article  Google Scholar 

  7. Bogunovic L, Kruse LM, Haas AK, Huston LJ, Wright RW (2014) Outcome of all-inside second-generation meniscal repair: minimum five-year follow-up. J Bone Jt Surg Am 96(15):1303–1307. https://doi.org/10.2106/JBJS.M.00266

    Article  Google Scholar 

  8. Boody BS, Omar IM, Hill JA (2015) Displaced medial and lateral bucket handle meniscal tears with intact ACL and PCL. Orthopedics 38(8):e738–e741. https://doi.org/10.3928/01477447-20150804-91

    Article  PubMed  Google Scholar 

  9. Boyd KT, Myers PT (2003) Meniscus preservation; rationale, repair techniques and results. Knee 10(1):1–11

    Article  PubMed  Google Scholar 

  10. Briggs KK, Kocher MS, Rodkey WG, Steadman JR (2006) Reliability, validity, and responsiveness of the Lysholm knee score and Tegner activity scale for patients with meniscal injury of the knee. J Bone Jt Surg Am 88(4):698–705. https://doi.org/10.2106/JBJS.E.00339

    Article  Google Scholar 

  11. Cannon WD, Vittori JM (1992) The incidence of healing in arthroscopic meniscal repairs in anterior cruciate ligament-reconstructed knees versus stable knees. Am J Sports Med 20(2):176–181. https://doi.org/10.1177/036354659202000214

    Article  PubMed  Google Scholar 

  12. Chiang C-W, Chang C-H, Cheng C-Y, Chen AC-Y, Chan Y-S, Hsu K-Y, Chen W-J (2011) Clinical results of all-inside meniscal repair using the FasT-Fix meniscal repair system. Chang Gung Med J 34(3):298–305

    PubMed  Google Scholar 

  13. Eggli S, Wegmüller H, Kosina J, Huckell C, Jakob RP (1995) Long-term results of arthroscopic meniscal repair. An analysis of isolated tears. Am J Sports Med 23(6):715–720

    Article  PubMed  CAS  Google Scholar 

  14. Espejo-Reina A, Serrano-Fernandez JM, Martin-Castilla B, Estades-Rubio FJ, Briggs KK, Espejo-Baena A (2014) Outcomes after repair of chronic bucket-handle tears of medial meniscus. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 30(4):492–496. https://doi.org/10.1016/j.arthro.2013.12.020

    Article  Google Scholar 

  15. Fairbank TJ (1948) Knee joint changes after meniscectomy. J Bone Jt Surg Br 30B(4):664–670

    Article  CAS  Google Scholar 

  16. Feng H, Hong L, Geng X, Zhang H, Wang X, Jiang X (2008) Second-look arthroscopic evaluation of bucket-handle meniscus tear repairs with anterior cruciate ligament reconstruction: 67 consecutive cases. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 24(12):1358–1366. https://doi.org/10.1016/j.arthro.2008.07.017

    Article  Google Scholar 

  17. Freedman KB, Nho SJ, Cole BJ (2003) Marrow stimulating technique to augment meniscus repair. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 19(7):794–798

    Article  Google Scholar 

  18. Fukubayashi T, Kurosawa H (1980) The contact area and pressure distribution pattern of the knee. A study of normal and osteoarthrotic knee joints. Acta Orthop Scand 51(6):871–879

    Article  PubMed  CAS  Google Scholar 

  19. Girolamo L, Galliera E, Volpi P, Denti M, Dogliotti G, Quaglia A, Cabitza P, Corsi Romanelli MM, Randelli P (2013) Why menisci show higher healing rate when repaired during ACL reconstruction? Growth factors release can be the explanation. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. https://doi.org/10.1007/s00167-013-2712-8

    Article  Google Scholar 

  20. Grant JA, Wilde J, Miller BS, Bedi A (2012) Comparison of inside-out and all-inside techniques for the repair of isolated meniscal tears: a systematic review. Am J Sports Med 40(2):459–468. https://doi.org/10.1177/0363546511411701

    Article  PubMed  Google Scholar 

  21. Haklar U, Donmez F, Basaran SH, Canbora MK (2013) Results of arthroscopic repair of partial- or full-thickness longitudinal medial meniscal tears by single or double vertical sutures using the inside-out technique. Am J Sports Med 41(3):596–602. https://doi.org/10.1177/0363546512472046

    Article  PubMed  Google Scholar 

  22. Henning CE, Lynch MA, Yearout KM, Vequist SW, Stallbaumer RJ, Decker KA (1990) Arthroscopic meniscal repair using an exogenous fibrin clot. Clin Orthop Relat Res 252:64–72

    Google Scholar 

  23. Henning CE, Yearout KM, Vequist SW, Stallbaumer RJ, Decker KA (1991) Use of the fascia sheath coverage and exogenous fibrin clot in the treatment of complex meniscal tears. Am J Sports Med 19(6):626–631

    Article  PubMed  CAS  Google Scholar 

  24. Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelborne KD (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29(5):600–613

    Article  PubMed  CAS  Google Scholar 

  25. Kalliakmanis A, Zourntos S, Bousgas D, Nikolaou P (2008) Comparison of arthroscopic meniscal repair results using 3 different meniscal repair devices in anterior cruciate ligament reconstruction patients. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 24(7):810–816. https://doi.org/10.1016/j.arthro.2008.03.003

    Article  Google Scholar 

  26. Krych AJ, Pitts RT, Dajani KA, Stuart MJ, Levy BA, Dahm DL (2010) Surgical repair of meniscal tears with concomitant anterior cruciate ligament reconstruction in patients 18 years and younger. Am J Sports Med 38(5):976–982. https://doi.org/10.1177/0363546509354055

    Article  PubMed  Google Scholar 

  27. Kubiak G, Fabiś J (2010) Clinical results of meniscus repair. Ortop Traumatol Rehabil 12(1):28–40

    PubMed  Google Scholar 

  28. Kurzweil PR, Lynch NM, Coleman S, Kearney B (2014) Repair of horizontal meniscus tears: a systematic review. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. https://doi.org/10.1016/j.arthro.2014.05.038

    Article  Google Scholar 

  29. Logan M, Watts M, Owen J, Myers P (2009) Meniscal repair in the elite athlete: results of 45 repairs with a minimum 5-year follow-up. Am J Sports Med 37(6):1131–1134. https://doi.org/10.1177/0363546508330138

    Article  PubMed  Google Scholar 

  30. Lyman S, Hidaka C, Valdez AS, Hetsroni I, Pan TJ, Do H, Dunn WR, Marx RG (2013) Risk factors for meniscectomy after meniscal repair. Am J Sports Med 41(12):2772–2778. https://doi.org/10.1177/0363546513503444

    Article  PubMed  Google Scholar 

  31. Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10(3):150–154. https://doi.org/10.1177/036354658201000306

    Article  PubMed  CAS  Google Scholar 

  32. Macconaill MA (1932) The function of intra-articular fibrocartilages, with special reference to the knee and inferior radio-ulnar joints. J Anat 66(Pt 2):210–227

    PubMed  PubMed Central  CAS  Google Scholar 

  33. Majewski M, Stoll R, Widmer H, Müller W, Friederich NF (2006) Midterm and long-term results after arthroscopic suture repair of isolated, longitudinal, vertical meniscal tears in stable knees. Am J Sports Med 34(7):1072–1076. https://doi.org/10.1177/0363546505284236

    Article  PubMed  Google Scholar 

  34. Makris EA, Hadidi P, Athanasiou KA (2011) The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration. Biomaterials 32(30):7411–7431. https://doi.org/10.1016/j.biomaterials.2011.06.037

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  35. McDermott ID, Sharifi F, Bull AMJ, Gupte CM, Thomas RW, Amis AA (2004) An anatomical study of meniscal allograft sizing. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 12(2):130–135. https://doi.org/10.1007/s00167-003-0366-7

    Article  CAS  Google Scholar 

  36. Naimark MB, Kegel G, O’Donnell T, Lavigne S, Heveran C, Crawford DC (2014) Knee function assessment in patients with meniscus injury a preliminary study of reproducibility, response to treatment, and correlation with patient-reported questionnaire outcomes. Orthop J Sports Med 2(9):2325967114550987. https://doi.org/10.1177/2325967114550987

    Article  PubMed  PubMed Central  Google Scholar 

  37. Nepple JJ, Dunn WR, Wright RW (2012) Meniscal repair outcomes at greater than five years: a systematic literature review and meta-analysis. J Bone Jt Surg Am 94(24):2222–2227. https://doi.org/10.2106/JBJS.K.01584

    Article  Google Scholar 

  38. Nyland J, Campbell K, Kalloub A, Strauss EJ, Kuban K, Caborn DNM (2018) Medial meniscus grafting restores normal tibiofemoral contact pressures. Arch Orthop Trauma Surg 138(3):361–367. https://doi.org/10.1007/s00402-017-2849-x

    Article  PubMed  Google Scholar 

  39. Paxton ES, Stock MV, Brophy RH (2011) Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 27(9):1275–1288. https://doi.org/10.1016/j.arthro.2011.03.088

    Article  Google Scholar 

  40. Pengas IP, Assiotis A, Nash W, Hatcher J, Banks J, McNicholas MJ (2012) Total meniscectomy in adolescents: a 40-year follow-up. J Bone Jt Surg Br 94(12):1649–1654. https://doi.org/10.1302/0301-620X.94B12.30562

    Article  CAS  Google Scholar 

  41. Perdue PS, Hummer CD, Colosimo AJ, Heidt RS, Dormer SG (1996) Meniscal repair: outcomes and clinical follow-up. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 12(6):694–698

    Article  Google Scholar 

  42. Rockborn P, Gillquist J (2000) Results of open meniscus repair. Long-term follow-up study with a matched uninjured control group. J Bone Jt Surg Br 82(4):494–498

    Article  CAS  Google Scholar 

  43. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS)-development of a self-administered outcome measure. J Orthop Sports Phys Ther 28(2):88–96. https://doi.org/10.2519/jospt.1998.28.2.88

    Article  PubMed  CAS  Google Scholar 

  44. Sallé de Chou, E, Pujol N, Rochcongar G, Cucurulo T, Potel J-F, Dalmay F, Ehkirch F-P, Laporte C, Le Henaff G, Seil R, Lutz C, Gunepin F-X, Sonnery-Cottet B, Société Française d’Arthroscopie (2015) Analysis of short and long-term results of horizontal meniscal tears in young adults. Orthop Traumatol Surg Res 101(8 Suppl):S317–S322. https://doi.org/10.1016/j.otsr.2015.09.009

    Article  Google Scholar 

  45. Steadman JR, Matheny LM, Singleton SB, Johnson NS, Rodkey WG, Crespo B, Briggs KK (2015) Meniscus suture repair: minimum 10-year outcomes in patients younger than 40 years compared with patients 40 and older. Am J Sports Med 43(9):2222–2227. https://doi.org/10.1177/0363546515591260

    Article  PubMed  Google Scholar 

  46. Spahn G, Plettenberg H, Hoffmann M, Klemm HT, Brochhausen-Delius C (2017) The frequency of cartilage lesions in non-injured knees with symptomatic meniscus tears: results from an arthroscopic and NIR- (near-infrared) spectroscopic investigation. Arch Orthop Trauma Surg 137(6):837–844. https://doi.org/10.1007/s00402-017-2672-4

    Article  PubMed  Google Scholar 

  47. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    Google Scholar 

  48. Tenuta JJ, Arciero RA (1994) Arthroscopic evaluation of meniscal repairs. Factors that effect healing. Am J Sports Med 22(6):797–802

    Article  PubMed  CAS  Google Scholar 

  49. Tuckman DV, Bravman JT, Lee SS, Rosen JE, Sherman OH (2006) Outcomes of meniscal repair: minimum of 2-year follow-up. Bulletin (Hosp Jt Dis (N Y, N Y)) 63(3–4):100–104

    Google Scholar 

  50. Uchio Y, Ochi M, Adachi N, Kawasaki K, Iwasa J (2003) Results of rasping of meniscal tears with and without anterior cruciate ligament injury as evaluated by second-look arthroscopy. Arthros J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 19(5):463–469. https://doi.org/10.1053/jars.2003.50109

    Article  Google Scholar 

  51. Unay K, Akcal MA, Gokcen B, Akan K, Esenkaya I, Poyanlı O (2014) The relationship between intra-articular meniscal, chondral, and ACL lesions: finding from 1,774 knee arthroscopy patients and evaluation by gender. Eur J Orthop Surg Traumatol Orthop Traumatol 24(7):1255–1262. https://doi.org/10.1007/s00590-013-1309-8

    Article  Google Scholar 

  52. Ververidis AN, Verettas DA, Kazakos KJ, Tilkeridis CE, Chatzipapas CN (2006) Meniscal bucket handle tears: a retrospective study of arthroscopy and the relation to MRI. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 14(4), 343–349. https://doi.org/10.1007/s00167-005-0678-x

    Article  CAS  Google Scholar 

  53. Veth RP (1985) Clinical significance of knee joint changes after meniscectomy. Clin Orthop Relat Res 198:56–60

    Google Scholar 

  54. Voloshin AS, Wosk J (1983) Shock absorption of meniscectomized and painful knees: a comparative in vivo study. J Biomed Eng 5(2):157–161

    Article  PubMed  CAS  Google Scholar 

  55. Wasserstein D, Dwyer T, Gandhi R, Austin PC, Mahomed N, Ogilvie-Harris D (2013) A matched-cohort population study of reoperation after meniscal repair with and without concomitant anterior cruciate ligament reconstruction. Am J Sports Med 41(2):349–355. https://doi.org/10.1177/0363546512471134

    Article  PubMed  Google Scholar 

  56. Westermann RW, Wright RW, Spindler KP, Huston LJ, Knee Group MOON, Wolf BR (2014) Meniscal repair with concurrent anterior cruciate ligament reconstruction: operative success and patient outcomes at 6-year follow-up. Am J Sports Med 42(9):2184–2192. https://doi.org/10.1177/0363546514536022

    Article  PubMed  PubMed Central  Google Scholar 

  57. Wilson AS, Legg PG, McNeur JC (1969) Studies on the innervation of the medial meniscus in the human knee joint. Anat Rec 165(4):485–491. https://doi.org/10.1002/ar.1091650404

    Article  PubMed  CAS  Google Scholar 

  58. Zimny ML, Albright DJ, Dabezies E (1988) Mechanoreceptors in the human medial meniscus. Acta Anat 133(1):35–40

    Article  PubMed  CAS  Google Scholar 

Download references

Funding

There is no funding source.

Author information

Authors and Affiliations

  1. Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany

    Andreas Hupperich, G. M. Salzmann, P. Niemeyer, M. Feucht, H. Eberbach, N. P. Südkamp & J. Kühle

Authors
  1. Andreas Hupperich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. M. Salzmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Niemeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Feucht
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. Eberbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. N. P. Südkamp
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Kühle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreas Hupperich.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hupperich, A., Salzmann, G.M., Niemeyer, P. et al. What are the factors to affect outcome and healing of meniscus bucket handle tears?. Arch Orthop Trauma Surg 138, 1365–1373 (2018). https://doi.org/10.1007/s00402-018-2989-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-018-2989-7

Keywords

Search

Navigation