Bucket Handle Meniscus Tears - Part 2
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- เผยแพร่เมื่อ 23 ก.ย. 2024
- Welcome to Part 2 of our bucket handle meniscus tear series. In this video, we will see what a bucket handle meniscus looks like during arthroscopic surgery and how we can repair these injuries.
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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.
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Excellent videos to increase patient understanding!
Thank you for taking the time to make these videos to show the repair process. I had this done a week ago and was interested in what the surgery actually entailed. I am so glad I sought a second opinion and was able to find a doctor who was willing and able to do a repair, rather than a partial meniscectomy. I could not wrap my head around how a partial meniscectomy and the resulting reduction in bearing area would be good in the long term.
@jeffreyalldredge1739,
It sounds like you have a good understanding of what the meniscus does. As you mentioned, losing the meniscus results in reduction of the surface area which in turn passes more load onto the cartilage on the ends of the bone.
I was watching part one and part two of this video with the intensity of a guy reading a 'Dear John' letter.
I get a better understanding of it as I was told that I had a bucket handle tear thank you🙏
Glad it was helpful!
Does the tissue in the knee feel tender where the suchers were placed post-op? And for how long? I would imagine so, but I'm curious what patients have reported.
Great video, BTW!
Can you comment on the typical types of possible displacement the "handle" portiion might experience? Is it possible under extreme flexion for the "handle' to be squeezed medially out of the joint, resulting in it being visible as a lump on the inner knee, and locking the knee from extension, and causing great pain? When this happens, it takes some effort and focus to overcome the pain and get it to snap back into place. Is this method of repair something that only certain surgeons will perform, or is it common? Of the various types of knee meniscous tears, is there a general rule for the types that might be sutured versus the types that call for removal. Finally, does meniscus tissue regenerate and mend? Thank you for the video, it is very enlightening!
Thank you for the detailed question. Apologies for the delay responding.
Regarding the displacement:
In a bucket handle tear, typically the segment that is torn shifts from its normal position and get stuck along the inner part of the knee called the intercondylar notch. It is possible for this part of the meniscus to shift back into its normal position with knee motion.
Regarding the lump on the inner knee:
Other types of meniscus tear can shift out of position along the inner (i'm assuming you mean the medial aspect of the knee). Perhaps this could be noticed. However, a lump or swelling could be a cyst that can develop with meniscus tears. In my experience this is more likely that a fragment of the meniscus. Keep in mind there are other things like loose fragments of cartilage that could "lock" the knee as you describe.
Regarding repair technique:
Many ortho surgeons will repair a meniscus. I am personally biased toward what's called an "inside-out" approach to a large meniscus tear like a bucket handle. This requires a surgical approach to the knee some surgeons may not be as familiar with. By "approach" I am referring to an incision which uses intervals between muscles to access the back of the knee. This has to be done well because of the nerves and blood vessels in the back. Using this particular approach, a surgeon has a lot of flexibility when suturing the repair and can typically place many more sutures for a more stable repair. The other option is an "all - inside" repair which can be done well for many types of repairs. I just believe the "inside - out" approach is better for a large bucket - handle repair. One should have a thorough discussion with the surgeon regarding any surgical plan - I can not emphasize this enough!!
Regarding repairability:
Some patterns of repair are more likely to heal than others. This is taken into consideration by the surgeon. However, many factors also come into play here: patient age, cartilage status of the knee and if there is any arthritis, alignment (bow-leg or knock - kneed), patterns of the tear, patient ability to comply with rehab etc.
Regarding "mending" and regenerating:
The meniscus can definitely "mend" (heal) after a repair. In some cases such as small tears associated with an ACL tear, the meniscus can heal by itself. Many types do not heal though. Once the tissue is gone, such as after a removal surgery, it does not regenerate.
I hope this answers your questions.
All the best
_______________________________________________________________________
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.
Just had surgery to fix this
What happens to the thread?
Edgar,
The suture (thread) remains in the knee. It is a very small suture.
Would you highly recommend fixing a bucket handle meniscus tear? Or is this something that get better with pt ? What are long term effects if goes untreated
D. R.
Thanks for the question. The quick answer is "yes". In general we are trying to fix bucket handle tears of the meniscus. In my practice, these tend to be in physiologically younger patients who are active with good knees. I would not just do PT unfortunately.
Take a look at my reply to shitji above as I go into some detail.
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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 thanks doctor, appreciate the reply.
Would a bucket handle tear still be repairable 2 years after injury?
Good question,
In my experience, the answer is "it depends".
A bucket handle meniscus that is stuck or "locked" out of its normal position for a long time (weeks to months) would be unlikely to be repaired but at the time of surgery I would still be ready to try and get a repair. When the meniscus is stuck out of position like that the tissue contracts and the meniscus will essentially deform and become impossible to repair.
If the meniscus is shifting in and out of position from time to time it may not undergo those changes and it's possible you could get a repair. I actually have a young man who injured his knee years ago with a similar injury. He is on my surgery schedule to fix an old unstable meniscus. The tissue looks good enough for a repair.
___________________________________________________________________________
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 doc. Mine does also shift positions on a daily basis. It never locks my knee though. Just changes place and I can feel it. Would that mean the tissue is still preserved?