Inside-out repair of bucket-handle meniscal tears in young patients: Long-term effectiveness in a high-risk population.

Objective: Bucket-handle meniscal tears (BHMT) represent a severe tear and are challenging to preserve. This study focused on BHMT repair with mainly inside-out vertical sutures using non-absorbable materials in stable knees (no associated anterior cruciate ligament tear) in patients under 18 years old, evaluating survival rates and clinical outcomes. We hypothesized that this technique could result in a low failure rate in this presumed at-risk population.

Methods: This retrospective study included 31 patients (31 knees) with a mean age of 13.7 years old at time of arthroscopic meniscal repair for BHMT (19 lateral and 12 medial) between 2010 and 2019.

Results: After a mean follow-up of 8.25 ± 2.9 years, seven clinical healing failures (22%) were observed, with 5-year survival rates of 77.4% for all lesions, 75% for medial menisci, and 78.9% for lateral menisci. The mean recurrence interval was 26.4 ± 18.8 mo. Clinical outcomes included mean pedi-IKDC scores of 83.7 ± 12.2 mean Kujala scores of 86.7 ± 10.9, Simple Value Test subjective functional scores of 82.5 ± 13.3, and Tegner scores of 6.4 ± 2.1.

Conclusion: This study demonstrates that sutured repair of bucket-handle meniscal tears in stable knees of patients under 18 years of age is associated with a relatively low failure rate, supporting the hypothesis that this technique is effective in a population traditionally considered at risk.

Level of evidence: IV; Retrospective study.