Bucket Handle Meniscus Tears - Part 1 

George, I'm happy you found the video helpful! My goal was to help patients better understand their injury.

Good question. The answer is "it depends". I have seen two general situations with bucket handle tears. 1) The meniscus will pop in and out of place. Essentially this means that the meniscus will be torn (obviously) but remain in the correct location within the knee. The tear is unstable so at time it will shift out of place and lock the knee up but it will shift back into the normal position. In this case, I have found the tear to be repairable. 2) The second situation is when the meniscus is locked and is stuck in that position. If it remains stuck out of place for a long time the tear can be very difficult if not impossible to fix. The reason for this is the tissue will slowly deform and contract and you physically can not push the meniscus back into place. In this situation it will have to be removed. I hope this answers your question. Good luck! _______________________________________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

@@JeffreyWittyMD thanks a lot dr.

LAKB24, Thanks for the question. There are many things to consider. The patient's age, activity level, any osteoarthritis in the knee, and many others. Typically in a younger, more active patient without osteoarthritis I would recommend surgery. As mentioned, the meniscus is a critical shock absorbing and stabilizing structure in the knee. _________________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

Thanks for the comment. Meniscus preservation should definitely be the preferred option for someone who is 27.

Same here!! Crying because it sounds so scary but I was told surgery as well.

Thanks for the question. It's hard to know what a "small" tear may mean. However, the fact that you use the term "bucket-handle" leads me to believe the tear is a significant injury. In the majority of situations (in particular young, active patients without knee arthritis) patients will benefit from surgery to repair the torn meniscus. This is because the meniscus serves a critical role in protecting the cartilage of the joint by acting as a shock absorber and also providing some stability. The tear is unlikely to heal and the meniscus tissue can shift in and out of place. When it is in the correct position it may not hurt much and your knee may feel ok. When it pops out of place it can become painful and prevent your knee from bending well. In a 28 year old with a bucket handle tear I typically recommend surgery. I would very highly recommend a repair instead of a partial menisectomy if at all possible but sometimes the meniscus is too badly torn. ___________________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure. All patients have been consented for use of any imaging, video, or other media.

You are welcome. Glad it helped.

Angelica, This is a good question. Yes, the meniscus can flip back into its normal position on its own. Based on your description of the popping it sounds like this could have happened to your knee. However, you still need to have this checked out. Even if the meniscus flips back, it is still torn and unstable and it can flip back out of place. _______________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

My son had a bucket handle tear and his kept flipping back and forth. He ultimately had to have surgery to repair. The repair failed, though, so he had a second surgery to remove the torn part that had not healed from the first surgery. Good luck!

I'm glad it was helpful! Good luck!

I think I got it off Amazon (search "knee model")

kshitji, Thanks for the question. Sorry for the delay. For a 25 year old active person a successful repair is BY FAR the more optimal situation. As you point out, the meniscus is critical when it comes to shock absorption in the knee. They also help with knee stability. We will try everything we can to try and get a repair and avoid trimming it. That being said, sometimes tears are not repairable and have to be trimmed (arthroscopic partial menisectomy). If a trim is done, care should be taken to only remove as little of the tissue as possible. Losing meniscus tissue can increase cartilage loading and lead to wear and tear of the cartilage and potentially osteoarthritis. For a repair, the postop rehab often requires a period with weight off the knee and crutches and rehab can take 4 - 6 months or so. At the conclusion of therapy I will often do a "functional test" in active patients to see how close they are to their uninjured leg to avoid having them return to high demand activities too early (this can avoid re-injury). Every surgeon has their own postop program so be sure and check with them regarding that. Best of luck! _________________________________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

If you can't get your knee straight the meniscus may be displaced out of its normal position. I typically recommend surgical repair of bucket handle meniscus tears. I would recommend prompt evaluation from an orthopaedic surgeon. I would avoid meniscus removal at all costs. ___________________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

Thanks for the question. I agree when you say a "complex" MM tear. The meniscus is classically divided into the anterior horn (toward the front of the knee), the midbody, and the posterior horn (part in the back of the knee). A bucket handle tear is when a tear that extends along a large area of the meniscus actually shifts from its normal position. See the videos in part 1 and part 2 for clarification. A horizontal tear is a different pattern of tear to the meniscus than a bucket handle tear. However, complex tearing can involve combinations as appears to be the case in the situation you describe. The patient in this case should make sure they followup promptly with an ortho surgeon to discuss the injury. Even though the tears are "complex", I will prefer to attempt repair in the right situations. I avoid trimming the meniscus (even small parts) if at all possible. _______________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

Thank you!

Thanks for the question. I'm sorry to hear about your injury. Typically during surgery the menisus is evaluated whether it can be repaired. We look for how bad the tear is, tissue quality etc. Sometimes, if the tear is old and the meniscus is shifted out of position, the tissue will undergo changes that make it very difficult to put back in correct position for a repair. Most of the time we are trying our best to get a repair, especially in younger patients who have good cartilage in their knee. Be sure to discuss your feelings regarding repair with your surgeon. Good luck! _______________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

Tough injury but you can get through it! Good luck!

Good luck! You can do it!

Real Milan, The quick answer to your question is this...after a bucket handle meniscus tear and an ACL tear the chances of walking again like before (as you put it) are very good. I will take your described situation and go through how its usually treated. Keep in mind, there are many details I am not aware of but lets just say you had a bucket handle tear of a meniscus and an ACL tear at the same time. For an active person, for this injury, we typically recommend surgery. Surgery for the meniscus could be a repair (more desirable) or a debridement of the torn tissue (often needed if the tissue is torn beyond repair). The ACL is treated (in the vast majority of situations) with a reconstruction where a graft (either your own tissue or donor tissue) is used to make a new ACL. The rehab after these surgeries can last a long time. I usually quote about 6 - 9 months of rehab after an ACL reconstruction. Rehab for a meniscus tear is done at the same time. If the surgery goes well and you are dedicated to rehab, the odds of getting back to your desired activity level can be very good. _________________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

Thanks for you question. Sorry to hear about your injury. Based on your description of the injury I would recommend surgery to repair the meniscus. The meniscus is vital to the knee and preserving it if at all possible is the most optimal outcome. Also, your ACL likely needs to be evaluated to make sure you don't have laxity as a result of a non-functional graft (the new ligament that was reconstructed after your first ACL surgery). All these factors can lead to early degenerative changes to the cartilage of the knee (osteoarthritis). I would recommend you seek out a orthopaedic sports medicine fellowship trained surgeon to evaluate this for you. _______________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

@@JeffreyWittyMD Thank you, I guess surgery is unavoidable and hopefully it can be repaired as the specialist mention about high chance of removing meniscus which I am trying to avoid the most.

Awesome! Thank you!

Hi there, I would say its common to have pain when you injure the knee but I have had some patients whose pain resolved but they continued to have symptoms such as slightly restricted knee motion and popping, catching and a locking sensation to the knee. Bucket handle tears can be caused by that mechanism as well as many others. Sometimes it happens so fast its hard to tell what happened honestly. Another concern that I would have is for a ligament injury (in particular the ACL) McMurray testing is a meniscus test but it does have its limitations regarding sensitivity and specificity for injury. A negative test doesn't fully rule out injury. It sounds like you have a joint effusion (fluid inside the knee). In my opinion, in a young active person with a clear injury, a MRI is the appropriate next step to get a clear understanding of the injury and to avoid missing anything. Good luck! _______________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

@@JeffreyWittyMD you are amazing, thank you so much doc! 🤠

Thanks for the question. A bucket handle meniscus tear should be repaired as soon as possible in young, more active, physiologically young people without osteoarthritis. A repair of an old tear can definitely be harder and in some cases impossible to do. If the patient has osteoarthritis of the knee (meaning there is no cartilage in the joint left) we don't typically do a repair. In that situation we perform a debridement of the tear (take out the torn tissue)

Sorry to hear about your injury. Based on your description of the injury, pain, symptoms etc I personally would get a MRI asap. I would push to have one ordered for you to get a closer look. There are certainly injuries that can present in exactly the way you mention that need appropriate evaluation and treatment. Even if the MRI is "normal" we now have the peace of mind to push through the rehab. _________________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

@JeffreyWittyMD Absolutely agree and will do.. I'll report back my findings for sake of possibly helping others. Thank you much doctor for all you do 🙏. Appreciate all the videos they're great

Yes! A bucket handle meniscus tear can definitely block knee motion. A repair of a tear is the most ideal situation and will restore the function of the meniscus. By repairing the meniscus back in its normal location, the block to motion is removed and the knee will not have any obstructions for full motion. In the case you describe above, definitely seek the care of an ortho surgeon. A young person (33 years) can have problems if a bad meniscus injury and ACL tear are not addressed. _______________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure. All patients have been consented for use of any imaging, video, or other media.

@JeffreyWittyMD thank you so much for replying,..I'm hoping this process will all be fast even though I was told it would be about a year recovery ..

missodessa, It's hard to exactly determine the nature of the meniscal injury as you have described. Any displaced (meaning the tissue is torn and has moved from its normal position) meniscus would by definition be a tear. However, there are certain situations called meniscus extrusion when the meniscus gets pushed out from the edge of the knee joint without a clear tear. I would suggest following up with an orthopaedic surgeon to clarify the report. A sports medicine fellowship trained ortho surgeon would be able to help you with this. ___________________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

@@JeffreyWittyMD Thank you so much for responding. I did eventually have a follow up with the Ortho she basically said it is pushed out a little and showed me where on the MRI scan. She actually didn't want me to see my scan thinking I wouldn't be able to understand what i was seeing but I have literally looked at tons of scans and have a grasp of where and what each ligament is. Oddly I feel an out of alignment issue on the opposite (medial) side. Unfortunately I feel like the dr doesnt really go into depth on my injury despite me asking a lot of questions. Almost as if she doesn't want to say anything that would be contradicted by how I heal but honestly I just want to know how serious the injury could be as I would need to start considering what a surgery would require of me and possibly prepare for that outcome. I also have a mild sprained MCL and a mild partially torn ACL, now I am scheduling PT and in 3 months will go for a follow up. I appreciate you giving me a little more clarity on what it means.

Josematthew50, Bucket handle meniscus tears can be unstable. Often the torn part of the meniscus can shift in and out of place. It's possible that when you were having the pain the meniscus was flipped out of position. The pop you describe was probably the meniscus shifting back into the normal position within the joint. This is why your pain and motion improved. I would highly recommend getting this evaluated by an ortho surgeon. This type of injury often requires surgery to fix the meniscus. ___________________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

@@JeffreyWittyMD thanks for the response doc appreciate it I have an ACL and meniscus surgery tomorrow.Wish me luck 🍀

Excellent question. When we use the long needles we are typically doing what we call an "inside-out" approach. This means that the needles are delivered from inside the knee and are retrieved outside the knee joint. This is done by making an incision (3 - 6cm or so) along the posteromedial (back of the knee along the inner side) or posterolateral (back of the knee along the outer side) part of the knee. As the needles pass out the back of the knee joint we can grab them like in the video. By doing this we can protect vital neurological and vascular structures in the back of the knee from getting stuck by the needle. I hope that answers your question.

@@JeffreyWittyMD Dear Dr., now I get it. It’s a very clever solution. Thanks a lot.

Good question, Typically patients with a displaced bucket handle meniscus tear will have a block to full extension (getting the knee all the way straight). It can be subtle though - perhaps only 5 degrees or so. Its also possible that i could prevent bending as well but in my experience I usually see it limit extension.

Good luck!

Good evening, Yes, during surgery there are two options. The first option is to repair the meniscus which is the ideal option because it will restore the function of the meniscus. However, there are many patient specific factors that go into making this decision (age, medical conditions, activity level, desire to complete the necessary rehab and any postop weightbearing restrictions among others). The second option is called a partial menisectomy which is when you trim out the torn tissue. This is not as ideal as it does not restore the meniscus function and removes part of the mensicus so that it doesn't work as effectively as a shock absorber in the knee. On occasion, the tear is so bad it can not be reliably repaired. In this case, removing part of the meniscus can relieve pain. ___________________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

Dylan, Thanks for the comment. The sutures (for their size) are pretty strong and usually we put many in during the repair. It is certainly possible to retear after an injury soon after surgery. However, the symptoms that you are having are not necessarily uncommon for where you are postop. You are doing the right thing by following up with your PT and surgeon. I would encourage you to stay consistent with your therapy and make sure you continue to voice any questions to your surgeon so that he/she knows how you are feeling and further evaluate if needed. Good luck! P.S. i asked the company i use and looks like each suture can hold about 150 - 175N ___________________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

Aaa, Thanks for your questions. In general, I would recommend surgery for a bucket handle meniscus tear. The fact that the knee will "lock" is concerning that the tear is unstable and displacing within the knee (see my video for the description of this). In active patients without significant arthritis, the meniscus will be essential to help protect the knee cartilage. In addition, the meniscus provides a stabilizing affect to the knee (helps the ACL). _____________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure. All patients have been consented for use of any imaging, video, or other media.

Javier, An ACL tear and a bucket handle meniscus tear are commonly seen together. We typically recommend surgery in this situation (patient age, activity level and other factors all need to be taken into consideration). ___________________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

Yanzi19, 0.3cm would be a 3mm tear. That is quite small and I wouldn't consider it a bad tear. Be sure to have it checked out anyway since there can be other associated injuries to the knee. _______________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

Dustin, Baker's cysts are pretty common and we see them frequently. Different conditions that cause fluid build up in the knee can cause them. Most frequently I see them with osteoarthritis but I have seen them in patients with meniscus tears as well.

@jeffreyb.wittym.d.7528 .. thank you for the reply! I had surgery and the tear was not repairable. It was almost torn right off, so they had to amputate the damaged cartridge. It is very tender for sure. The surgeon did not talk to me post surgery, just left instructions for a follow up in 3 weeks, so don't even know when to start physiotherapy. By the way, I love your channel and videos!