What Is a Bucket Handle Meniscus Tear?

A bucket handle meniscus tear is a serious knee injury in which the meniscus, a C-shaped wedge of cartilage in the knee joint, rips away from the back of the knee and flips forward like a bucket handle.

A bucket handle meniscus tear is one of the most serious kinds of meniscus tears, common injuries that cause pain, swelling, and limited mobility. While more difficult to recover from than other types, a bucket handle meniscus tear can be treated successfully.

This article explains the symptoms of bucket handle meniscus tears, treatment options, and tips for preventing this type of injury.

Symptoms of a Bucket Handle Tear

A bucket handle tear of the meniscus occurs on the outer portion of the meniscus cartilage, causing a vertical slice through the meniscus and resulting in symptoms similar to other types of meniscus tears. 

These common symptoms include:

• Pain along the joint line
• Swelling of the knee
• Tendency for the knee to "giveaway"
• Clicking within the knee
  
• Locking of the knee
• Limited motion of the knee joint
  

A bucket handle meniscus tear may be more likely to cause a locked knee joint than other types of tears. A locked knee occurs when the knee cannot fully straighten from a bent position. Because the bucket handle fragment of meniscus cartilage is displaced into the front of the joint, it prevents the knee from fully straightening.

That said, it is possible to still be able to walk when you have a bucket handle meniscus tear.

Diagnosis

An orthopedic specialist should be able to determine if you have a meniscus tear by examining your knee. Often an MRI is performed to determine the type and location of the meniscus tear. Bucket handle tears are clearly visible on MRIs, and often show the classic "double PCL" sign where the meniscus fragment rests alongside the posterior cruciate ligament (PCL) causing the ligament to look duplicated.

Bucket handle meniscus tears are often associated with an anterior cruciate ligament injury (ACL tear). In this common sports injury, one of the major knee ligaments is damaged, and at the same time, the bucket handle meniscus tear occurs. If you suffer an ACL tear, your healthcare provider should also check the meniscus.

Treatment Options

The usual treatment for a bucket handle meniscus tear is surgery, but less aggressive options are possible including medication.

Surgical Treatment

This type of injury is not considered a medical emergency, but arthroscopic knee surgery is usually performed as soon as possible so that the knee can bend and straighten normally. There are two options for repairing a bucket handle meniscus tear:

• Partial meniscectomy: This is a surgery performed to remove the damaged portion of the meniscus. The torn meniscus is removed from the joint causing the remaining meniscus to be smaller than normal. This is considered the best option if it seems that the meniscus won't heal on its own. One advantage of removing the torn meniscus is that the recovery is much faster.
• Meniscus repair: In a meniscus repair, the torn parts of the meniscus are surgically sewn together, and the cartilage is placed back in its proper position. This procedure is only possible when there is a good blood supply to the area. Healing after a meniscus repair usually takes longer than a meniscectomy.
  

Non-Surgical Treatments

In rare instances, a bucket handle meniscus tear might heal on its own. Some healthcare providers may recommend ice, a nonsteroid anti-inflammatory medication (NSAID), and rest to see if an injury will heal.

For another non-invasive treatment, some healthcare providers may try platelet rich plasma (PPP) therapy. This therapy involves taking platelet cells taken from your blood and injecting them into the injured area. These platelets have growth factors that can help the meniscus heal. Some research has shown that PPP therapy can facilitate healing and improve function.

Rehabilitation

Rehabilitation is an essential part of a successful recovery. A physical therapist will craft a plan specific to your needs that will center around exercises to restore strength, balance, and range of motion in the knee joint.

Bucket Handle Meniscus Tear Recovery Time

The total time it takes to recover from a bucket handle meniscus tear depends on a number of factors, including the treatment chosen, adherence to recommended physical therapy, and whether or not there are any complications of surgery.

Generally speaking:

• Most athletes who have a partial meniscectomy return to sports and activities within six weeks.
• Those who have a meniscus repair may not reach this milestone for four months or longer.
  

Prevention

To protect your knees, healthcare providers recommend keeping other muscles strong. This includes building up:

• Abdominals
• Hips
• Hamstrings
• IT (iliotibial) band, which runs along the back of the legs

Easing into new activities and "listening" to your body can also help you avoid injuries. Wearing a knee brace may help, but the research on its benefits is not conclusive.

Summary

A bucket handle meniscus tear is a serious injury that results in the meniscus tearing and flipping in the joint. It can be extremely painful and cause knee locking. However, it is treatable. Surgery is often necessary, but your healthcare provider may recommend less invasive measures. Maintaining good overall muscle strength and being cautious about engaging in sports activities can help you avoid these injuries altogether.