Bucket Handle, Inside-Out Medial Meniscal Repair: A Technique Video.

Abstract

Background: Bucket-handle medial meniscal tears represent a common subset of meniscal injuries, particularly among younger athletes. In cases requiring operative intervention, the inside-out technique for medial meniscal repair remains the gold standard.

Indications: We present a technique video for the repair of a bucket-handle medial meniscal tear in a young athlete who sustained a meniscal injury while playing soccer, resulting in mechanical symptoms. The tear was noted to remain within the peripheral vascular zone of the meniscus, making him a favorable candidate for operative repair.

Technique description: The bucket-handle medial meniscal injury was confirmed with a diagnostic arthroscopy. The identified tear was subsequently reduced, debrided, and repaired via an inside-out technique using a mechanized suture passer. After appropriate repair, a femoral notch microfracture-a marrow stimulation procedure-was performed.

Results: After the operation, the patient was expected to recover without complications and achieve return to sports and full recovery within 4 to 6 months. Surgical intervention was anticipated to result in symptom resolution, improved functional outcomes, and high patient satisfaction.

Discussion/conclusion: While the inside-out technique remains the gold standard for medial meniscal repair, the documented relative rate of failure for this procedure is not insignificant in high-level athletes. This technique video addresses some potential pearls and pitfalls to maximize the likelihood of success. It is imperative to accurately assess the extent of the injury during diagnostic arthroscopy and to strongly consider the regenerative capacity of the meniscus in establishing the appropriate treatment plan. Passing vertical mattress sutures with a mechanized device may obviate the need for a second surgical assistant. When finalizing the repair, sutures should be tied in full extension with the assistance of an arthroscopic knot pusher; direct visualization should be maintained to ensure adequate meniscal reduction and appropriate tension of both the knots tied and the tissues secured. Lastly, we advocate a femoral notch microfracture procedure to introduce marrow elements, platelets, growth factors, and cells into the articular space to provide a biologically favorable healing environment.

Patient consent disclosure statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.