Review Question - QID 220076

Bucket handle (Figure A) and radial (Figure B) meniscal tear arthroscopic repairs have demonstrated similar improvements in clinical outcomes and acceptable reoperation rates across cohorts.

Meniscal tears are common sports-related injuries in young athletes, with treatment options including non-operative versus operative (partial meniscectomy versus repair) depending on the morphology of the meniscus tear, root involvement, patient symptoms, and patient activity demands. The best candidates for repair are meniscal tears with the following characteristics: peripheral tears in the red-red zone (vascularized region); those with a lower rim width correlating with the distance from the tear to the peripheral meniscocapsular junction (better blood supply); and tears 1-4 cm in length. Though vertical (including bucket-handle) and longitudinal tears, rather than radial, horizontal, or degenerative tears, have traditionally been considered better candidates for repair, robustly matched data has shown equivalent results with the repair of radial tears, especially those at the root level that renders the knee functionally ameniscal.

Wu et al. published a propensity-matched analysis of outcomes comparing radial and bucket-handle meniscal tear repairs. The authors note that full-thickness radial meniscal tears render the meniscus nonfunctional and have historically been treated with partial meniscectomy. Aiming to assess clinical outcomes and reoperation rates of radial meniscal repair and to compare them to bucket-handle meniscal repair, the authors reviewed twenty-four patients (18 male, 6 female; mean age, 22.8 ± 11.9 years) who underwent repair of a radial meniscal tear and followed them out to a mean of 3.5 years compared to a comparison pool of 70 bucket-handle repairs. They found that the matched radial and bucket-handle groups demonstrated similar reoperation-free survival rates at 2 years (88.9% and 94.4%, respectively) and 5 years (77.8% and 87.7%, respectively), as well as VAS and IKDC scores that improved significantly after surgery, with no difference noted between the groups. They concluded satisfactory clinical outcomes for radial meniscal tear repair at short-term follow-up are achievable.

Oosten et al. published a systematic review of several existing techniques with favorable biomechanical outcomes in radial meniscus tear repair. The authors identified 20 studies that performed mechanical testing on 21 different radial meniscal tear repair techniques and found that the greatest reported mean load-to-failure (LtF) were the transtibial 2-tunnel + 4 horizontal inside-out sutures (191.2 N ± 17.3, cadaver) and all-inside double vertical repair (146.3 N ± 36.2, porcine). They concluded that less-invasive all-inside vertical techniques reinforced with sutures parallel to the tear instead of standard inside-out horizontal sutures may improve the strength of the repair, while transtibial 2-tunnel augmentation may also increase the strength of radial meniscus tear repairs.

Figure A is a T1-weighted sagittal MRI sequence of the knee showing a "double-PCL" sign with a bucket handle medial meniscus tear flipped into the notch. Figure B is a PD fat-saturated sagittal MRI sequence of the knee showing a radial tear of the lateral meniscus.

Incorrect Answers:
Answers 2-4: Repairs of radial and bucket handle meniscal tears, in the current literature, have demonstrated similar improvements in Visual Analogue Scale and International Knee Documentation Committee scores, restoration of preoperative Tegner Activity Scale scores, and acceptable reoperation rates.