Bucket Handle Meniscus Tears - Part 1
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- เผยแพร่เมื่อ 14 ก.ค. 2022
- There are different types of meniscus tears in the knee. One of the more severe injuries is the bucket handle tear. It has this name because of the pattern of the tear. This video will review bucket handle tears of the knee and is the first part of a two part video series.
The second video will demonstrate actual arthroscopic video of a bucket handle tear.
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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.
This is the clearest explaination I have seen. Had my right knee done in 2011, now due my left knee done in 4 weeks time.
This is the best video!!!
Very well explained. Thank you very much!
Awesome explanation
This video is great. I'm having surgery to repair this very soon.
Really helpful video, finally understand what I’ve done and what my surgery will entail in 2 weeks 👍
George,
I'm happy you found the video helpful! My goal was to help patients better understand their injury.
Thank you, Dr. Jeffrie for answering all queries and such an amazing video. I have bucket handle on my lateral miniscus and was confused whether to go for surgery or not, but you have explained well.
I'm glad it was helpful! Good luck!
V nicely explained TQ 🙏
Thank you so much! Your respond to others here has helped me so much to understand the critical of getting surgery asap to protect the meniscus and prevent further damages.
You are welcome. Glad it helped.
Ughh i wish you could do my surgery you are very good at explaining and making me feel like its not AS bad as I probably thought it was. Had a doctor tell me he wanted to remove the whole thing and I immediately made an appointment for a second opinion. Im 27 and can’t deal with that sort of stuff right now.
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.
I just subscribed to your channel! Thank you!!
Awesome! Thank you!
I just did this to my knee and I’m waiting on surgery! You do an excellent job describing it to where I understand the surgery. Thank you so much
Tough injury but you can get through it! Good luck!
Well explained sir
Tore mines 4 months ago! At work. And the workscom took forever to get me to a specialist. Just saw him today.So far my knee has gotten better did my own therapy from TH-cam videos and research.. My knee doesn’t buckle and I’m able to do one leg squats on it now. You recommend surgery?? Barely gonna start my actual therapy 😮💨
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.
@JeffreyWittyMD I know you made this video a long time ago I just recently had this surgery I’m abt to be 4 months in I had it on my lateral meniscus my surgeon was telling me I shouldn’t wrestle again just because the ways the knee goes in I was thinking he was better or removing have any thoughts on it is it possible to come back after 6 months of hard pt I take pt extra serious in he’s telling me that I shouldn’t take the chance
Hi, thanks a lot for such an informative video!
So, i got an MRI done recently. This is what it says: Bucket handle tear of medial meniscus with torn meniscal fragment displaced in intercondylar region in continuity with posterior root and anterior horn.
After consulting, I've been advised to get surgery done & ideally they would remove this fragmented part.
I'm 25& big time into trekking and yoga.
Surgery means removing a part of the shock absorber, i.e., meniscus, won't this have further implications?
How many months post op do i need for my knee to function at 90/100%?
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.
I just found out that i have a tear after probably 3 years of pain and symptoms, doctor said it's a front tear and surgery is the only solution but as i search on TH-cam, im seeing a good amount of people saying also some doctors saying that it can only cause knee arthritis later on...my doctor said he was going to sow it back together so i don't know what to do if i should try to fix it alone with exercises for it aince mine is acute tear or go into surgery?
Hi! My MRI showed that I have a small bucket-handle type tear of the lateral meniscus. I really do not want surgery but felt pressure from the surgeon to do this. I am 28 years old, I feel no pain now, can walk, extend my leg etc. (I couldn’t before) but as the days go on I keep getting better and better.
I am scheduled for a partial meniscectomy, possible meniscus repair.
Is it possible for this to heal on its own?
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.
I couldn't walk for three weeks because I had bucket handle so I couldn't straighten my leg. I did surgery 2 month ago I had bucket handle and ACL but after 1 months in one scar the blood filled and they opened that scar again I had a surgery again after 1 month they stop blood bleeding and I started physiotherapy I had problem to break my knee on 90 degree so they decided to put me on sleep and do that. I had challenges now those 3 4 days I'm walking sometime without crutches but I'm not stable I'm not doing well walking maybe I don't have
confidence or muscle is not ready yet, My knee is swelling I'm putting ice on it but orthoped says to me that knee and leg is Ok we were late with recover but it will be ok.
I wanted to ask you will i walk again like i was before bucket handle
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.
Going in this week
Good luck!
Is the cartridge not torn out or reduced at any point during surgery? I’m worried I lose some of the vision and have future issues which the structure of me knee and have possible issues later
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.
Is it possible for it flip back on its own? I was having pain, swelling, and constant popping and locking where I couldn’t straighten my knee. One day when I was walking it popped different than normal and now I’ve been able to straighten my leg with no problems. I’m still hesitant to walk on it without a knee brace.
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!
Where do you stick out those long needles inside the knee joint ? I couldn’t visualize the procedure. Thank you.
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.
will the knee lock in knee extension only or both flexion extension ?
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.
Is their an ideal time to get a repair done? Is repair more difficult after many months?
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)
Hey!
I currently am awaiting an MRI scan to determine whether I do indeed have a bucket handle meniscus tear.
Is it common to feel no pain at all when you have a bucket handle meniscus tear, and be able to straighten your leg fully, but not inverted (e.g, past 0/180 degrees straight.
I injured my knee playing soccer, where my knee hyperextended forward and backwards very quickly (buckled whilst in a bolt up right (stood up) position). Can bucket handle meniscus tears be caused by this? As there was no twisting involved in the incident of the knee, it was just forwards and backwards movement.
I did the Murray’s test, and all experiments were painless for me, just some bad aches when he pushed my straight leg upwards.
Additionally, the knee seems to have gotten much better since the injury, and pain hadn’t been a problem for me at all (except from when I initially injured it). But yeah, as it stands I don’t know whether to believe this diagnosis… or if it’s just join effusion, as I have a lot of liquid on my knee joint especially around the knee cap and below the patella.
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!
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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! 🤠
I am 38 and just found out from my Dr that i have bucket handle & ACL tear on my right knee. May i know at what condition the Dr will decide whether the bucket handle tear only need stitching or need it to be trimmed or removed? I don't want it to be trimmed or removed because I am worried about long term.
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.
Hello. 3 days ago I twisted my knee and had extreme pain that forced me to lay down on the ground on my back. When I tried to extend my leg I heard a loud pop and have not been able to walk on it or fully extend the leg since. Went to the ER, did Xrays and they said no signs of a break or dislocation. Couple days later I visited my primary care doctor and she told me that Its most likey is a sprain or tear. She gave me meds and recommended rest and heat. I have not noticed any discoloration, but have been having some swelling a few days later but do have pain if try to extend the leg past 40 degrees or flex the leg all the way. I am 44 and live a very active lifestyle (gym 4-5 days a week for more than 12 years consistent). I have not yet been recommended an MRI. Any ideas how long it may take before I can fully extend my knee or walk on it ? And what signs should I look for that would be an indicator that surgery may be a viable option over rest ? Thanks
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
I am 38 and had ACL reconstruction 12 years ago and the knee has been relatively unstable ever since. I injured myself again in tennis and MRI shows bucket handle tear with piece of meniscus flipped into joint. There's not much pain anymore but I can't straighten my leg fully. Is surgery the only way to fix it? I am quite reluctant for surgery as my previous ACL reconstruction definitely didn't go as well as I hoped for, thanks!
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.
On this bucklet tears where the knee is locked...would it straighten back out again after surgery is done and how long after???can't walk,been limping since i had this tear along with a complete acl tear..waiting on surgery now..33 yr old female
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 ..
what does it mean when your findings are "Mid body lateral meniscus has been displaced from the joint line. No evidence of meniscal tear." Im trying to understand my results and you're the first person I've seen used the word displaced but I have no tear so Im confused what it actually means.
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.
Jesus Christ how did I even do this to my body 😅
I recently had meniscus surgery on a bucket handle tear and was curious as to the strength of the sutures used if you could help provide some info? I'm 7 weeks post-op and had a few slips along the way, one of which was maybe bodyweight + a little bit more of force from behind (door closing on me at a 65 degree leg angle in relation to 90 degree being parallel to the floor)? Now that I'm "walking", there some form of catching most the time and joint line pain some of the time so I am curious to know if this is a symptom of broken sutures/the force would have ripped them and if so, caused potential failure of the surgery? Or is this all just common rehab pains bc my knees weaker right now? (Physio + Ortho have both said they think things are okay)
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.
Hi Doc I have a bucket handle tear and felt some pain when straightening the knee today suddenly out of nowhere this made a weird click sound I thought that I fucked my knee once again but when I tried to straighten my knee it caused no pain I don’t know what I should do rest or start doing normal stuff again.
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 🍀
I have a confirmed bucket Handle Tear that was verified by a MRI. They also found a Bakers cyst. I have done some research, is a Bakers cyst common to accompany a Bucket Handle Tear?
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!
On mri found that medial meniscus bucket gandle tear. But i don't have any severe pain and swelling. And sometimes my knee get locked when i try to bend knee after keeping my knee straight for a while.currently i don't have any stability issue. Should i prefer surgery...?
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.
What if you have a bucket handle flipped meniscus and acl torn
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.
Is 0.3 cm medial meniscus tear bad?
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.