Second-look arthroscopic evaluation of bucket-handle meniscus tear repairs with anterior cruciate ligament reconstruction: 67 consecutive cases

Arthroscopy. 2008 Dec;24(12):1358-66. doi: 10.1016/j.arthro.2008.07.017. Epub 2008 Sep 13.


Purpose: To evaluate arthroscopic second-look bucket-handle meniscus tear (BHMT) repairs using different suturing techniques.

Methods: Between May 2002 and September 2006, 122 consecutive cases underwent arthroscopic repair surgery, including 40 males and 24 females (63 with concurrent anterior cruciate ligament [ACL] injury and 1 isolated BHMT) having 67 (60 medial and 7 lateral) repairs available for second-look arthroscopy evaluation. Inclusion criteria for reparability included reducible tears involving red-red and red-white zone without obvious additional complex tears and tissue degeneration, and concurrent ACL injury and/or isolated BHMT. Patients were excluded if they had combined ligaments injuries other than ACL. The arthroscopic suturing techniques, classified according to different involvement of meniscus zones, consisted of typical inside-out and all-inside suture repair with suture hook.

Results: In a series of 64 second-look cases with 67 repairs, which showed healing after an average of 26 months (range, 14 to 66 mos), 55 repairs (82.1%) were completely healed (and clinically asymptomatic) in 53 cases; 5 cases (5 repairs; 7.5%) had joint line tenderness (incompletely healed and clinically asymptomatic); and 7 repairs (6 medial, and 1 lateral; 10.4%) failed, with recurrent locking or catching in 4 cases (and clinically asymptomatic in 2 cases). The overall success rate, including completely healed and incompletely healed cases, was 89.6%. Four failures occurred in failed ACL-reconstructed knees.

Conclusions: For large bucket-handle meniscus tears involving red-red and red-white zones, an arthroscopic hybrid suture technique with ACL reconstruction achieves high anatomic healing results, with an overall meniscal healing rate of 89.6%, including 82.1% completely healed and 7.5% incompletely healed. The failure rate was 10.4% in the average 26-month follow-up period.

Level of evidence: Level IV, therapeutic case series.

MeSH terms

  • Anterior Cruciate Ligament / surgery*
  • Anterior Cruciate Ligament Injuries*
  • Arthroscopy / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Menisci, Tibial / surgery*
  • Patient Selection
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Second-Look Surgery / methods*
  • Second-Look Surgery / rehabilitation
  • Tibial Meniscus Injuries*
  • Treatment Failure
  • Treatment Outcome
  • Wound Healing