Working Diagnosis:
Acute, displaced bucket handle tear of the right lateral meniscus.

Treatment:
The patient was offered admission for surgery. However, given logistical issues, there was not an orthopaedic surgeon available to operate until the next day. The patient elected to be discharged to return home to New York and have her operation done there. The patient was placed in a hinged knee brace and given crutches.

Outcome:
When we followed up with the patient, she reported having had her arthroscopic surgery performed within one week of returning home. She is doing well and is expected to make a full recovery.

Author's Comments:
This case presented an initial diagnostic challenge, as her exam was limited and the differential was broad. However, we were fortunate to get her an MRI from the ED and to involve the appropriate specialists in order to formalize her plan of care. As described in Lim et al., bucket handle meniscal tears are subdivided into three types. Type 1 involves upward rotation of the displaced fragment. Type 2 involves downward rotation of the displaced fragment. Type 3 involves reverse movement of the displaced fragment. Type 1 is the most common, involving about 69% of these injuries. Most often the type is not able to be diagnosed until visualized intraoperatively.

Editor's Comments:
Bucket handle meniscus tears require operative management in order to reduce the displaced fragment. There have been failure rates cited less than 20% with bucket handle meniscus repair, which is low and shows great success. But, recent studies have shows that the failure rates for bucket handle meniscus repairs are actually around 23% after two year follow-up.

References:
Lim HC et al. Intra-articular patterns of bucket handle meniscal tears and its relation to reducibility. Clin Ortho Surg. 2012;4:129-133.

Moses, MJ, et al. "Clinical outcomes following surgically repaired bucket-handle meniscus tears". Phys Sportsmed. 2017 Sep;45(3):329-336.

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