Review Question - QID 1375

The history and MR images are consistent with lateral meniscus bucket handle tear. On the coronal view the meniscus is displaced into the notch and on the sagittal view it is displaced anteriorly. The best next step in management is arthroscopy with meniscus repair followed by immediate joint mobilization or a short period of immobilization. Prolonged knee immobilization is not advisable in meniscal repair patients.

The animal model experiment by Dowdy et al found that dogs that underwent meniscus repair followed by mobilization had a significantly greater collagen percentage in the healing meniscal incision than those that were cast immobilized for 10-weeks (44.6% vs 27% collagen content).

Level 4 evidence from Barber found that successful meniscal healing occurred in 92% of repairs done with ACL reconstructions, but only 67% of meniscus repairs done in stable knees with no ACL injury. They concluded that no modification of an ACL reconstruction accelerated rehabilitation program is required for meniscus repairs performed in conjunction with ACL reconstruction.

Arthroscopic images of a displaced lateral meniscus bucket handle tear in a left knee are shown in Illustration A. Multiple methods of repair can be utilized including all-inside (Illustration B showing lateral meniscus repair with vertical mattress stitch), inside-out, and outside-in suture fixation techniques.