Working Diagnosis:
Bucket Handle Meniscus Tear

Treatment:
A bucket handle meniscus tear (BHMT) is a longitudinal tear that creates a flap of the meniscus, resembling a handle, that displaces into the knee joint. They are relatively uncommon, accounting for 10-15% of all meniscal tears. Their unique handle shape that protrudes into the joint, leads to significant mechanical symptoms such as locking and pain. BHMTs are often caused by knee twisting or pivoting motions, common in sports like volleyball, basketball, or football. Diagnosis is made with MRI, which can visualize the tear's shape and extent. Due to the nature of the BHMT, definitive treatment is with surgical intervention, involving either meniscectomy, repair or meniscal transplant.

Outcome:
After discussion of nonoperative and operative treatment options, the patient opted for definitive surgical correction and underwent successful meniscal transplant. Postoperatively, physical therapy was initiated and at the one month follow up the patient demonstrated significant improvement in knee stability and function, with marked reduction in pain and locking symptoms.

Author's Comments:
The patient did not return to playing volleyball for the remainder of the season. At the one month follow up after the patient's meniscal transplant, she demonstrated significant improvement in her symptoms. Gradual return to play was initiated at the two month follow up with increasing weight bearing activity and strength conditioning.

Editor's Comments:
This patient had traumatic knee pain and was found to have a bucket handle meniscal tear. While many acute knee injuries can be conservatively managed, in patients with a mechanism for meniscal injury and have significant pain or locking should be further evaluated with MRI. Notably this patient had a bucket handle meniscal tear. These BHMT are notorious for causing significant pain and locking and generally need orthopedic consultation for surgical repair, transplant or meniscectomy.

References:
1. Griffin LY, Agel J, Albohm MJ, et al. Noncontact anterior cruciate ligament injuries: risk factors and
prevention strategies. J Am Acad Orthop Surg. 2000;8(3):141‐150.

2. Kopf S, Beaufils P, Hirschmann MT, Rotigliano N, Ollivier M, Pereira H, Verdonk R, Darabos N, Ntagiopoulos P, Dejour D, Seil R, Becker R. Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc. 2020 Apr;28(4):1177-1194. doi: 10.1007/s00167-020-05847-3. Epub 2020 Feb 13. PMID: 32052121; PMCID: PMC7148286.

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