Bucket Handle Meniscus Tear

What is a bucket handle meniscus tear?

It's a tear in the crescent-shaped wedge of tough, rubbery cartilage in your knee called your meniscus. Your meniscus acts like a cushion between your thigh bone (femur) and shin bone (tibia). It absorbs shock in your knee and keeps it stable.

With a bucket handle tear, a tear forms in the center of your meniscus. This opening pushes the inside edge of your meniscus toward the middle of your knee. Because the ends of the meniscus are still attached to the knee joint and the outer edge remains curved, it looks like a handle on a bucket.

What are the different types of bucket handle meniscus tears?

In each knee, you have a lateral and medial meniscus. The lateral meniscus curves around the outer edge of your knee. The medial meniscus curves around the inner edge. A bucket handle tear can affect your lateral or medial meniscus, but it’s more common in the medial meniscus.

Who does a bucket handle tear affect?

A bucket handle meniscus tear can happen to anyone, but it's more likely to occur if you play sports or exercise frequently. Twisting your knee while running or pivoting may cause a bucket handle meniscus tear.

How common is a bucket handle meniscus tear?

A torn meniscus is one of the most common knee injuries. Bucket handle tears make up about 10% of all meniscus tears. This type of injury is more common in young men or people assigned male at birth.

How does a bucket handle meniscus tear affect my body?

Without treatment, a bucket handle tear can lead to arthritis in your knee and long-term knee pain. A meniscus tear also decreases your knee’s stability. Without a stable knee, you have a higher chance of getting another knee injury, like an ACL tear.

What are the symptoms of a bucket handle meniscus tear?

If you have a bucket handle meniscus tear, you may notice:

• Inability to straighten your leg completely.
• Knee pain.
• Knee locking, catching or feeling like you can’t move your knee.
• Popping sound at the time of the injury.
• Stiffness and swelling in your knee.

If you tear your meniscus, you might not have severe pain right away. You may even feel like you can continue to walk or play sports. But over the next two to three days, your knee may become swollen, stiff or painful.

What causes a bucket handle meniscus tear?

Most bucket handle tears happen when you suddenly twist or turn your knee during sports or exercise. Playing sports that require you to pivot or quickly start and stop is a common cause.

You can also tear your meniscus if you slip, fall or step on an uneven surface. Some people accidentally twist their knee while doing everyday activities, such as getting out of bed or up from a chair.

How is a bucket handle meniscus tear diagnosed?

First, your provider will perform a physical examination. Tell your provider how your knee feels and when you first noticed symptoms.

Your provider might perform a McMurray Test or Thessaly test, where they gently turn or move your leg in different directions. This test helps your provider determine what type of knee injury you may have.

What tests diagnose a bucket handle meniscus tear?

After your physical exam, you may need imaging tests. These tests take pictures of the inside of your knee so your provider can see the meniscus and other tissues. Your tests may include:

• X-rays highlight bones and solid structures. They can’t show a meniscus tear, but they can help rule out other causes of knee pain, such as osteoarthritis.
• MRI provides detailed images of your meniscus and other structures in the knee. This test can often reveal meniscus tears and other types of knee injuries.

How is a bucket handle meniscus tear treated?

If you have a bucket handle meniscus tear, your treatment options may include:

Meniscus surgery

The most common treatment for a bucket handle meniscus tear is meniscus surgery, also called knee arthroscopy. During this surgery, your surgeon uses an arthroscope (tiny camera) to see inside your knee. The arthroscope projects images on a screen so your surgeon can see the meniscus without a large incision.

Bucket handle meniscus tears often respond well to meniscus surgery because they usually have good blood supply. During your surgery, your surgeon moves the “bucket flap” portion of the meniscus back to its proper place and attaches it with stitches. Recovery from this surgery takes six weeks to three months.

Meniscal transplantation

If your meniscus can't be repaired with surgery, your provider may talk with you about meniscal transplantation. Also called a meniscus transplant or meniscus replacement, this is surgery to replace a damaged or missing meniscus. If you had your meniscus removed with a prior surgery because it couldn’t be repaired, meniscal transplantation may be an option. During this surgery, your provider transplants a meniscus from a deceased donor.

A meniscus transplant can help prevent osteoarthritis and future knee pain. You might be eligible for this surgery if:

• Your provider can't repair your meniscus with other treatments.
• Your other knee structures are healthy and you don’t have arthritis.
• You’re under age 50 and active.

Platelet-rich plasma (PRP)

Platelet-rich plasma is a treatment that uses your own blood to repair injuries and encourage healing. Your provider may recommend PRP therapy for a bucket handle meniscus tear, usually after you’ve had meniscus surgery. The platelets and plasma from your blood boost healing in torn or damaged tissues. This therapy uses a concentrated form of these blood parts to treat injuries.

During PRP therapy, your provider:

1. Draws some of your own blood from your arm with a needle.
2. Places the blood in a special machine that separates the platelets and plasma from the other blood parts. This process creates the PRP that your provider will use.
3. Injects the PRP into your knee with a needle.

Physical therapy

Your provider may prescribe physical therapy, which includes special exercises you do after surgery. These exercises help build strength and flexibility and are tailored to your injury and needs. Your physical therapist guides you through your exercises during your sessions. You continue working on some exercises at home. Following your physical therapy plan gives you the best chance for a successful recovery.

How can I reduce my risk of getting a bucket handle meniscus tear?

There’s no guaranteed way to prevent a bucket handle tear. But if you’re active or play sports, these steps can help you lower your chance of any type of knee injury:

• Don’t jump into a new exercise routine too quickly. Gradually increase your time and intensity of exercise as you gain strength and endurance.
• Listen to your body. If you have pain, stop the activity and talk to your provider.
• Practice regular strength training for your lower body. Strong leg and gluteal muscles help support and stabilize your knee.
• Wear a knee brace if you have a knee that could be unstable or weak.
• Wear proper footwear and protective gear during sports.

What is the outlook for a bucket handle meniscus tear?

The outlook after a successful bucket handle meniscus repair is favorable. Most people who have successful meniscus surgery go back to normal activities after recovery. With a repaired or transplanted meniscus, you have a lower chance of getting osteoarthritis in your knee later.

Will a bucket handle tear heal on its own?

Some minor meniscus tears can heal on their own with rest and careful home care. However, most bucket handle tears don't get better on their own. The separated portion is often stuck in the middle of your knee. This piece can't move back or heal by itself, so you need a surgeon to put it back in place.

When should I see my healthcare provider?

If you have symptoms of a bucket handle tear or heard a pop in your knee, see your provider. Even meniscus tears that aren’t very painful can result in osteoarthritis and other knee problems later if you don’t receive treatment.

When should I go to the ER?

After any type of surgery, you should watch for signs of rare complications. If you recently had knee surgery, seek emergency care if you have:

• Chest pain.
• Cough with blood coming up.
• Fever.
• Knee that feels hot to the touch.
• Lots of drainage (blood, pus or fluid) coming out of your incisions.
• Pain or swelling that gets worse, even after resting and raising your leg.
• Redness or red streaks in the knee area.
• Trouble breathing.

A note from Cleveland Clinic

A bucket handle meniscus tear may sideline you for a few weeks or months. But this injury doesn’t have to stop you from enjoying exercise and sports again. After successful treatment, most people resume their normal activities. Talk to your provider about the best options for meniscus repair based on your needs and lifestyle.