Bucket handle tear

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A bucket-handle tear of the knee is a specific type of meniscal injury characterized by a longitudinal tear of the medial or lateral meniscus, where a displaced inner fragment resembles the appearance of a "bucket handle". [1] This displaced meniscal fragment often remains attached at the anterior and posterior horns but dislocates into the intercondylar notch of the knee joint. Such injuries can cause mechanical symptoms, including locking and restricted movement of the knee.

Contents

Anatomy

The knee joint contains two crescent-shaped fibrocartilaginous structures, the menisci (medial and lateral), which serve as shock absorbers and stabilize the joint during movement. Each meniscus has an outer vascular zone (red-red zone), which has a good blood supply and healing potential as well as a central avascular zone (white-white zone), which has limited healing capability. [2]

The medial meniscus is more prone to injury due to its firm attachment to the joint capsule and limited mobility. The lateral meniscus is more mobile and less frequently injured.

Pathophysiology

A bucket-handle tear occurs when a significant longitudinal tear develops, often as a result of trauma or excessive twisting forces applied to the knee. The displaced fragment can flip into the intercondylar notch, impeding normal joint motion. The injury is most commonly seen in:

The injury frequently occurs in conjunction with anterior cruciate ligament (ACL) tears.

Clinical presentation

Patients with a bucket-handle tear typically present with the following symptoms: [3]

The patient may report a history of a twisting injury or sports-related trauma

Diagnosis

Diagnosis of a bucket-handle tear is based on a combination of clinical examination and imaging studies:

Physical examination

Imaging

Plain Radiographs (X-rays): While X-rays cannot visualize meniscal tears, they may rule out bony injuries. Occasionally, a joint effusion may be observed.

Treatment

Management of bucket-handle tears is primarily surgical, as these tears often cause mechanical symptoms and are unlikely to heal on their own due to the displacement of the meniscal fragment. Treatment approaches include:

Arthroscopic Surgery

Rehabilitation

Postoperative care includes: [8]

Return to sports is usually permitted after 4–6 months, depending on the success of meniscus repair and concomitant injuries (e.g., ACL tear).

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<span class="mw-page-title-main">Osteochondritis dissecans</span> Ischemic bone disease

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<span class="mw-page-title-main">Medial meniscus</span> Cartilage formation in the human knee

The medial meniscus is a fibrocartilage semicircular band that spans the knee joint medially, located between the medial condyle of the femur and the medial condyle of the tibia. It is also referred to as the internal semilunar fibrocartilage. The medial meniscus has more of a crescent shape while the lateral meniscus is more circular. The anterior aspects of both menisci are connected by the transverse ligament. It is a common site of injury, especially if the knee is twisted.

<span class="mw-page-title-main">Lateral meniscus</span>

The lateral meniscus is a fibrocartilaginous band that spans the lateral side of the interior of the knee joint. It is one of two menisci of the knee, the other being the medial meniscus. It is nearly circular and covers a larger portion of the articular surface than the medial. It can occasionally be injured or torn by twisting the knee or applying direct force, as seen in contact sports.

The knee examination, in medicine and physiotherapy, is performed as part of a physical examination, or when a patient presents with knee pain or a history that suggests a pathology of the knee joint.

<span class="mw-page-title-main">Meniscal cartilage replacement therapy</span> Medical intervention

Meniscal cartilage replacement therapy is surgical replacement of the meniscus of the knee as a treatment for where the meniscus is so damaged that it would otherwise need to be removed.

<span class="mw-page-title-main">Unhappy triad</span> Medical condition of the knee

The unhappy triad, also known as a blown knee among other names, is an injury to the anterior cruciate ligament, medial collateral ligament, and meniscus. Analysis during the 1990s indicated that this 'classic' O'Donoghue triad is actually an unusual clinical entity among athletes with knee injuries. Some authors mistakenly believe that in this type of injury, "combined anterior cruciate and medial collateral ligament disruptions that were incurred during athletic endeavors" always present with concomitant medial meniscus injury. However, the 1990 analysis showed that lateral meniscus tears are more common than medial meniscus tears in conjunction with sprains of the ACL.

<span class="mw-page-title-main">Coronary ligament of the knee</span> Ligament of the knee

The coronary ligaments of the knee are portions of the joint capsule which connect the inferior edges of the fibrocartilaginous menisci to the periphery of the tibial plateaus.

<span class="mw-page-title-main">Meniscus tear</span> Rupturing of the fibrocartilage strips in the knee called menisci

A tear of a meniscus is a rupturing of one or more of the fibrocartilage strips in the knee called menisci. When doctors and patients refer to "torn cartilage" in the knee, they actually may be referring to an injury to a meniscus at the top of one of the tibiae. Menisci can be torn during innocuous activities such as walking or squatting. They can also be torn by traumatic force encountered in sports or other forms of physical exertion. The traumatic action is most often a twisting movement at the knee while the leg is bent. In older adults, the meniscus can be damaged following prolonged 'wear and tear'. Especially acute injuries can lead to displaced tears which can cause mechanical symptoms such as clicking, catching, or locking during motion of the joint. The joint will be in pain when in use, but when there is no load, the pain goes away.

<span class="mw-page-title-main">Transverse ligament of knee</span> Ligament of the knee

The transverse or (anterior) meniscomeniscal ligament is a ligament in the knee joint that connects the anterior convex margin of the lateral meniscus to the anterior end of the medial meniscus.

The pivot-shift test is one of the three major tests for assessing anterior cruciate injury or laxity, the other two being the anterior drawer and Lachman test. However, unlike the other two, it tests for instability, an important determinant as to how the knee will function. In fact, it is instability, not simply the injury to the anterior cruciate ligament itself, that places the menisci at future risk, and gives rise to the feeling that the "knee is not secure" or "may give out".

<span class="mw-page-title-main">Discoid meniscus</span> Human anatomic variant affecting the lateral meniscus of the knee

Discoid meniscus is a rare human anatomic variant that usually affects the lateral meniscus of the knee. Usually a person with this anomaly has no complaints; however, it may present as pain, swelling, or a snapping sound heard from the affected knee. Strong suggestive findings on magnetic resonance imaging includes a thickened meniscal body seen on more than two contiguous sagittal slices.

Posterolateral corner injuries of the knee are injuries to a complex area formed by the interaction of multiple structures. Injuries to the posterolateral corner can be debilitating to the person and require recognition and treatment to avoid long term consequences. Injuries to the PLC often occur in combination with other ligamentous injuries to the knee; most commonly the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). As with any injury, an understanding of the anatomy and functional interactions of the posterolateral corner is important to diagnosing and treating the injury.

The absent bowtie sign is a radiologic sign indicative of a meniscal tear in the knee joint. On sagittal magnetic resonance (MR) images, the body of the meniscus normally looks like a bow tie, with two distinct segments. The absent bowtie sign is present when there is a lack of two segments seen on consecutive sagittal MR images. This sign can be used to diagnose "bucket-handle" tears of the mensici, which are longitudinal tears with displaced fragment(s). The "handle" is created when the inner meniscal fragment is displaced into the intercondylar notch.

The double posterior cruciate ligament sign is a radiological finding seen on magnetic resonance imaging of the knee, specifically in the context of a bucket-handle tear of the medial meniscus. It refers to the appearance of a duplicated posterior cruciate ligament, where the displaced fragment of the torn medial meniscus lies parallel and inferior to the PCL, mimicking a second ligament. The double PCL sign has high specificity for meniscal tears when noted on MRI.

References

  1. ↑ "The Radiology Assistant : Meniscal pathology". radiologyassistant.nl.
  2. ↑ De Smet, Arthur A. (September 2012). "How I Diagnose Meniscal Tears on Knee MRI". American Journal of Roentgenology. 199 (3): 481–499. doi:10.2214/AJR.12.8663. ISSN   0361-803X . Retrieved 17 December 2024.
  3. 1 2 "Meniscal Tears - Knee & Sports - Orthobullets". www.orthobullets.com. Retrieved 17 December 2024.
  4. ↑ "Meniscus Tears - OrthoInfo - AAOS". www.orthoinfo.org. Retrieved 17 December 2024.
  5. ↑ Wright, D H; De Smet, A A; Norris, M (September 1995). "Bucket-handle tears of the medial and lateral menisci of the knee: value of MR imaging in detecting displaced fragments". American Journal of Roentgenology. 165 (3): 621–625. doi:10.2214/ajr.165.3.7645481. ISSN   0361-803X . Retrieved 17 December 2024.
  6. ↑ Khamis, Mai E. M. (1 December 2016). "Value of magnetic resonance imaging signs in diagnosis of bucket handle tear". The Egyptian Journal of Radiology and Nuclear Medicine. 47 (4): 1493–1500. doi: 10.1016/j.ejrnm.2016.08.006 . ISSN   0378-603X . Retrieved 17 December 2024.
  7. ↑ Alsowaigh, Mouad; Albishi, Waleed; Alfridy, Afnan; Alsabbagh, Laila; Alahaidib, Adel; AlAhaideb, Abdulaziz (1 May 2023). "The treatment of bucket handle meniscus tear using "the pulling suture technique": A new surgical technique". International Journal of Surgery Case Reports. 106: 108137. doi:10.1016/j.ijscr.2023.108137. ISSN   2210-2612. PMC   10131046 . Retrieved 17 December 2024.
  8. ↑ "Rehabilitation Protocol for Arthroscopic Meniscal Repair" (PDF). MassGeneral. Retrieved 17 December 2024.
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