gms | German Medical Science

Objectives: Knee joint meniscus bucket handle tears define a severe medical condition. Meniscus retaining surgery is commonly pursued in order to maintain its important biomechanical function. Not much evidence has been published on factors that influence postoperative survival of such pathology.

Purpose of this study was to identify patient, meniscus rupture and surgical characteristics that influence the outcome and clinical healing following operative repair of bucket handle tears.

Methods: Between 02/2006 and 10/2012 a total of thirty-eight patients (14 women, 24 men) with bucket handle tears underwent surgical meniscus repair. There were 27 isolated repairs and 11 with concomitant ACL replacement. Patients were analyzed on average 44.4 months (range 15 - 96 months) after surgery by the use of standardized subjective scoring instruments (Lysholm, International Knee Documentation Committee [IKDC], Knee Injury and Osteoarthritis Outcome Score [KOOS] and Tegner Activity Scale [TAS]). To identify factors affecting the outcome and suture survival patient-specific, trauma-specific as well as meniscus and surgery-specific factors were collected. Patients were divided in two groups with healed menisci (Group 1) and re-rupture subjects (Group 2). Meniscus re-rupture was defined as a clinical failure.

Results: There were 25 patients with healed menisci and 13 (34.2%) that sustained re-rupture and underwent either partial meniscectomy (n= 8) or re-suture (n= 5). Group 1 achieved slightly higher outcome compared to Group 2 (Lysholm: 87.8 vs. 84.3 (p= 0.35), IKDC: 86.9 vs. 85.7 (p= 0.67), KOOS: 91.3 vs. 90.5 (p= 0,74). TAS was better for Group 2 (5.9 vs. 6.8 (p= 0.36)).

Strong impact to result in a significantly increased outcome was identified for higher age, subjective knee joint stability, high preoperative Lysholm-Score, short trauma-to-repair time, previous anterior cruciate ligament (ACL)-reconstruction and a smaller number of sutures to fulfill meniscus repair.

Lower patient age, male gender and higher activity level had the strongest impact to provoke re-rupture.

Conclusion: Clinical outcome after meniscus bucket handle suture is satisfying. Re-rupture rate among this collective was 34.2%. Clear risk factors were identified for diminished clinical healing and outcome.