Why do you need surgery for a bucket-handle meniscus tear?

Meniscus tears are among the most common knee injuries that require surgery. Are there certain types of meniscus tears that can heal without surgery? And are there some tears that automatically do require surgery? In this Ask Dr. Geier video, I discuss a bucket-handle meniscus tear and its treatment options.

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Kamran asks:
I recently had an injury, and my MRI result shows that I have bucket-handle type tear in medial meniscus with a double PCL sign. Do you think it has to be operated on? Any chance that it can be treated by physiotherapy?

A bucket-handle meniscus tear is a tear in which the inner torn fragment can flip back and forth like the handle of a bucket. It is a common type of tear in young athletes.

It almost always requires surgery for a few reasons. On one hand, it doesn’t heal on its own. Also, it often flips into the center of the knee and blocks knee motion.

Fortunately, it is often possible for a surgeon to repair a bucket-handle meniscus tear by placing sutures or anchors. It is a longer recovery than a partial meniscectomy, but if the repair heals, the patient maintains the entire meniscus to serve as a shock absorber in the future.

[DrDavidGeier]

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[shawncooney]

Hello, I’m a 54 yo and suffered severe knee pain from doing squats. MRI confirmed bucket handle tear of medial meniscus. Didn’t want surgery but ended up having to go surgical route due bucket tear flipping over into knee joint keeping me from not being able to extend leg which led to severe limping. Injury occurred 10/30/23 with surgery on 12/13/23. Full weight bearing with pain after surgery. Started PT day one post op. Still cannot fully extend leg but have made progress from 22 degrees to 8 degrees. Swelling and some pain still present but getting better.STRONGLY recommend PT as soon as possible. For all of you currently going through this stay positive and best of luck with your recovery!

[hazeleyes]

I had a bucket handle tear on my right lateral meniscus, and had the repair surgery done 2 years ago. It took me about 6 months to fully recover, but the surgery was definitely worth it because my knee was locking from the tear getting caught by the femur. 10/10 recommend repairing the tear.

[pllastmanstanding]

For anyone out there suffering from this injury who doesn't want to or cant get surgery.
I had many set backs but after almost a year it's finally healed.
The key for me is doing bodyweight exercises. Doing lots of Yoga and then doing heavy weights especially squats.
Just stick with it

[SportGuyDMV]

I just got diagnosed with a bucket handle tear. I am a active person who bowls, plays basketball and trail biking. It happened in August 2022. My knee was locking, cracking, stability was very poor, and fatigue would set in very quickly when standing. Stupidly, I continued bowl periodically while I had a bucket handle tear and probably caused more damage. I opted to get surgery and was just thankful it was repairable. Since I am 27 getting a partial menisectomy I think would have been the wrong choice. I am 6 days post opt just got off the crutches. I am still icing and elevating. Also just working on bending my knee. If you're active recovery can be really boring and a big part of this process is the mental side.

[quinnyshootsfilm]

Got surgery on mine 13 years ago huge tear and bucket handle. Got surgery to repair it and it was a 6 month healing process and another 2 months to get back to where I was as an athlete. It tore again a year later and I had it removed as it was too shredded up from the last tear. It was a 3 week recovery and since then I’ve been fine but also have been strengthening it for years and don’t grind rails and jump 20 stair sets of stairs anymore like I did before so my knee has been in great shape.

[opatija]

Dear dr. Geier
On a previously unstable knee (2 ACL reconstructions), I had a new injury on 14/09/2019. It was a medial meniscus injury, a bucket-handle.
I was operated on 17/09/2019. The operator told me it was a horizontal (and vertical) tear along the entire meniscus. He used three different techniques to fix it (sewing, pin) and said he was pleased with the outcome.
The early postoperative period passed excellent. I was able to flex my leg up to 90 degrees painlessly within few days (I made sure not to cross it at all). With the Compex I started to regain strength in the quadriceps very quickly, and everything seemed to go according to plan.
In my overwhelming desire to be able to recover by the ski season (planned for 3.5 months from surgery), it looks like I made a big mistake :(
As I was feeling great (knee painless), 18 days after surgery I started walking without crutches. Instead of rehab, I went to work. It was still fine until 6 weeks after surgery when I went on a trip with my family. In 3 days we walked 50 kilometers and at one point I felt a sharp pain in the area of ​​the posterior horn of the medial meniscus. It has been exactly 2 weeks since then and my knee is still sore, swollen. :(
Made a new knee MR and get a different opinion from a radiologist and orthopedist. One opinion says that it is a loosening of the sutures in the area of ​​the posterior horn, while another says that it is just a finding of still unconnected structures.
As you indicated in the video that you would like us to share our experiences, I decided to share mine.
I just don't know what to do next, so I would ask your opinion as well.
The agreement is to saddle for at least a week, and if the pain and swelling does not go away, we plan to have the revision surgery
Thank you in advance
NV

[vishalnahar]

It’s been about 10 days since my surgery for a bucket handle meniscus tear. I’ve been advised no weight bearing for first 3 weeks and 50% from 3-6 weeks.. and full weight bearing post 6 weeks. The Surgeon mentioned that normally the healing of a bucket handle surgery takes longer than partial meniscus tears.. He also mentioned the challenge of blood flow without the ACL.. meaning he had to puncture a few areas around to have a blood flow to the meniscus..
I want to know what I need to do to increase my chances of healing..

[SM-euot]

I did this surgery last month, and I’m doing good and slowly recovering with ACL repair ...

[sapphicnickel]

8 years ago I had a bucket handle tear repaired on my left knee and 5 days ago I had a bucket handle tear repaired in my right knee. Both times the knee was locked up. I’m in pain and the rehab is lengthy, but ultimately worth it.

[oleanderson]

I had a bucket handle meniscus tear almost 20 years ago. I did not have surgery. My knee will still “ lock up” sometimes, but I know how to unlock it quickly and I do it without even thinking about it. Other than occasionally locking up, I have zero pain and I’m a very active person. Stupid I know, but it works for me…..

[robwilliam]

I had this tear on the medial meniscus in 2017. Surgeon removed 70% of it and now I have severe arthritis at 48, and doing everything I can to avoid a knee replacement.

Make sure you find a good surgeon because the quality of your life after depends on it

[xXSkyBlingXx]

I just had a bucket handle repair today. Doctor said I could return to sports in 5-6 months. That hurt to hear, but im ready to start my journey with the PT!

[cousiwa]

I lost my ACL when I was 14. They told me that I was too young for a knee recon. So... I swear they gave me a bucket handle to stabilise the joint. They told me what I can do and what I can't do and that following their rules my knee will carry me with no problems for the remainder of my life. My surgeonwas an eminent Scottish professor in orthopaedics who only did knees. I'm in my late 50s now, and I have never had any trouble with my knee since he went into my knee. Have you ever heard of a bucket handle to replace a acl?

[madhuchandarsundaravel]

I'm 38. I had ACL reconstruction surgery in my left knee 3 years back and had my meniscus repaired with sutures at that time. I've been playing intense Badminton and my BMI indicates that I'm obese. A year ago my left knee locked up for 3 days and I took Flexura-D and it subsided. MRI stated that I have 5 tears in my left knee lateral and medial menisci. But the pain came only from two tears on the lateral meniscus, the posterior horn and the bucket handle tear. The pain due to posterior horn tear is something I can bear, but not the pain due to bucket handle tear as I couldn't extend or bend my knee backwards. Was considering surgery but then as there was no locking up of the knee at the time of doctor visit, he recommended physiotherapy. I didn't do it for more than a few days and jumped back to Badminton. After a month's play, knee locked up again and got better after taking the same tablet as before. Stopped playing Badminton and took a break for 3 months from any activity. I've been skeptical about having a surgery again. It's okay if it is a meniscus repair, but I could never let my meniscus be trimmed as it will lead to Arthritis soon. Some doctors have started speaking against meniscus trimming surgery as latest study shows no better results in patients who've had their meniscus trimmed and it only leads to early Arthritis. It's been two months since I joined a gym now and all I've been doing there is strengthening my knee. I'm able to run now, do squats and have full mobility of my knee. But i'm not sure if this will hold up if I start playing Badminton, but I'm not gonna go for a surgery to get my meniscus trimmed unless the knee keeps locking up every time I walk. Always think twice and do your research before going under the knife.

[zackdean]

I just recently had a leg cramp in bed while sitting up with my legs both bent towards the same direction, saw a orthopedic surgeon today had an mri and multiple and X-rays and was diagnosed with a bucket handle tear. last April I was Diagnosed with a grade 3 acl rupture, partial torn medial menisci and fractured tibia… I avoided surgery and after a great half year of PT and practically feeling normal again my leg randomly attacked itself (23yrs old). I see the doc again tomorrow to find out more.

[kel]

I had surgery for a Medial Meniscus tear in the early 1990's. In those days the offending meniscus was removed, recovery was about 6 weeks. Unfortunately, while recovery was quick, I am now dealing with the prospect of knee replacement surgery due to severe osteoarthritis in the effected knee.

[tylerstudios]

Tore my medial meniscus (bucket handle) in my left knee during wrestling practice 6 years ago and had arthroscopic surgery to repair. Re-tore the same medial meniscus in my left knee during track practice 2 weeks ago and had the same arthroscopic surgery 4 days ago. They repaired it again but his time used additional injection of platelet rich plasma from my blood. I’m not sure what exactly that did to help but my recovery has been smoother this time than 6 years ago. I’m also not sure if my knee is somehow more prone to the tear or if it was weaker after the first tear but I hope it doesn’t happen again down the road.

[gardeningwithkbloom]

Hey, my name is Krishn, I was trying to go professional in soccer I am only 17 but I suffered a lateral meniscus Bucket Handle Tear and most likely getting surgery next week, could you give me any tips or recomendations? wether it can recover by itself or is surgery 100% necessary for me to play soccer again...appreciate it, I just want healthy knees and dont want arthritis in the future man too much stress and I just turned 17

[Siknessferro]

Just got surgery today, 20 minutes. Most my meniscus is removed, is i can get back to training and in about a month with physical therapy. I own a gym so I have to teach. I was already getting arthritis in my knees and my fingers from what I do. But this tear was awful, had it a week before surgery. Worst pain and couldn’t sleep for a week. Instant relief, I mean it’s swollen from
Surgery and hurts, but I can straighten my leg out and bend it without it feeling like it’s gonna explode