A bucket-handle tear is a special kind of displaced circumferential tear of the knee meniscus, where the free bit flips over like the handle of a bucket.
Page updated March 2024 by Dr Sheila Strover (Clinical Editor)
The knee becomes 'locked' when the longitudinal tear flips over. trapping the condyle from moving freely.
Illustration of the meniscus with the displaced longitudinal tear, which resembles a flipped bucket handle.
Illustration of a bucket, where the handle can flip either way. So sometimes a bucket-handle tear of the meniscus can spontaneously reduce, with motion restored.
Natural history of the 'bucket-handle'
The circumferential (longitudinal) tear occurs first, and the locking follows later, but with each episode the tear may extend and the 'handle' bit may flip over more easily. Eventually the 'handle' may break and its free end may flap in the joint, causing periodic catching or locking. Eventually the torn bit may break off altogether, to float in the joint as a 'loose body', also causing intermittent catching or locking.
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Quote from peer-reviewed paper:
"Although repair is attempted whenever possible, meniscus resection [is] usually performed for a tear that cannot be repaired or less likely to heal afterwards, for example: bucket handle tear in the avascular zone.... "
Citation: Alsowaigh M, Albishi W, Alfridy A, Alsabbagh L, Alahaidib A, AlAhaideb A. The treatment of bucket handle meniscus tear using "the pulling suture technique": A new surgical technique. Int J Surg Case Rep. 2023 May;106:108137. doi: 10.1016/j.ijscr.2023.108137. Epub 2023 Apr 11. PMID: 37075502; PMCID: PMC10131046.
Routine management of bucket-handle tears
In most cases of bucket-handle tear, today's surgeon will generally attempt a repair procedure, rather than cutting away the 'handle', although sometimes there is simply too much damage to preserve the whole meniscus.
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Quote from peer-reviewed paper:
"As the menisci are critical for load transmission, stabilization, lubrication, and proprioception of the knee joint, preservation of meniscal tissue is of great clinical importance....Although partial meniscectomy may reduce pain....in the short-term, removal of meniscal tissue results in cartilage degeneration, premature development of osteoarthritis, and poor long-term outcomes"
Citation: Muench LN, Achtnich A, Krivec L, Diermeier T, Woertler K, Braun S, Imhoff AB, Willinger L. Clinical outcome and healing rate after meniscal bucket handle tear repair. BMC Musculoskelet Disord. 2022 Dec 5;23(1):1063. doi: 10.1186/s12891-022-06037-7. PMID: 36471335; PMCID: PMC9721037.
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Quote from peer-reviewed paper:
"few complications occur after arthroscopic repair of bucket-handle meniscus tears, and the results are relatively durable with 84.6% survival at 1 year, 78.4% survival at 2 years, and 69.9% survival at 3 years....given the young, athletic population that is affected by this injury pattern—surgeons should attempt meniscal repair at the index surgery when presented with a bucket-handle tear"
Citation: Saltzman BM, Cotter EJ, Wang KC, Rice R, Manning BT, Yanke AB, Forsythe B, Verma NN, Cole BJ. Arthroscopically Repaired Bucket-Handle Meniscus Tears: Patient Demographics, Postoperative Outcomes, and a Comparison of Success and Failure Cases. Cartilage. 2020 Jan;11(1):77-87. doi: 10.1177/1947603518783473. Epub 2018 Jun 29. PMID: 29957019; PMCID: PMC6921958.
Management of a locked bucket-handle tear
A patient may find that the displaced portion flips back on its own, with immediate relief of locking - but the locking may recur, and each episode may cause the tear to extend. The best route is for the surgeon to flip the torn bit back early and suture it in position until it heals.
Forum discussions
- My Meniscus & Its Repair-- Was It Supposed to Be This Bad?
A post-op diary of the early days of meniscal repair after a bucket-handle tear.
- Lateral Meniscus Tear - To Scope or Not to Scope??!?
A personal story that illustrates how a bucket-handle tear can 'self-reduce'.
Types of meniscal tear -
Bucket-handle symptoms -
2012 - Meniscal tears - decisions regarding repair - by Professor Adrian Wilson (Knee Surgeon) (Knee Surgeon)