Comparable Outcomes After Bucket-Handle Meniscal Repair and Vertical Meniscal Repair Can Be Achieved at a Minimum 2 Years’ Follow-up
Authors: Moatshe Gilbert , Cinque Mark E. , Godin Jonathan A. , Vap Alexander R. , Chahla Jorge , LaPrade Robert F. 
Published: August 2017

Background:

Meniscal tears can lead to significant pain and disability, necessitating surgical treatment. Nondisplaced vertical tears are usually smaller in size and can be repaired in most cases; however, bucket-handle tears are usually larger and displaced, and the repair of these tears can be challenging.

Purpose/Hypothesis:

The purpose was to report the outcomes after inside-out vertical mattress suture meniscal repair of bucket-handle tears and to compare these outcomes with those of patients who underwent repair of nondisplaced vertical meniscal tears with a minimum of 2 years’ follow-up. The hypothesis was that the outcomes of bucket-handle tear repair would be comparable with those of nondisplaced vertical meniscal tear repair.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Patients who underwent inside-out repair of a bucket-handle meniscal tear or a nondisplaced vertical meniscal tear with a minimum 2 years’ follow-up were included in this study. Patients were excluded if they had a diagnosis of a meniscal root tear, underwent a concomitant procedure for a chondral injury, or underwent previous surgical treatment of the same meniscus. Subjective questionnaires were administered preoperatively and postoperatively, including the Lysholm score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Short Form–12 (SF-12) physical component summary (PCS) and mental component summary (MCS), the Tegner activity scale, and patient satisfaction.

Results:

Thirty-two patients underwent repair for vertical meniscal tears (mean, 7 sutures), while 38 patients underwent repair for bucket-handle meniscal tears (mean, 11 sutures), with a mean follow-up of 3.1 years (range, 2-6 years). There were no significant differences in the preoperative outcome scores between the 2 groups. Significant improvements in patient-reported outcome scores from preoperatively to postoperatively were found in both groups. A direct comparison of the bucket-handle tear group to the vertical tear group did not exhibit significantly different SF-12 PCS scores (54.0 vs 51.6, respectively; P = .244), SF-12 MCS scores (55.3 vs 52.5, respectively; P = .165), WOMAC scores (8.1 vs 9.0, respectively; P = .729), Lysholm scores (84.6 vs 80.8, respectively; P = .276), Tegner scores (5.5 vs 5.5, respectively; P = .970), and patient satisfaction scores (7.4 vs 7.7, respectively; P = .570). Additionally, a comparison of acute and chronic bucket-handle tears demonstrated no significant difference in outcome scores.

Conclusion:

The repair of bucket-handle meniscal tears with multiple vertical mattress sutures using an inside-out technique yielded improved results and low failure rates, comparable with outcomes after repair of nondisplaced vertical meniscal tears. The findings of this study support repairing bucket-handle meniscal tears with multiple vertical mattress sutures when possible.