Restoring Stability - A Case of a Decade Old Triple Bucket Handle Meniscus Tear with an Anterior Cruciate Ligament Injury - Case Report

Sep 29, 2026

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Bucket handle meniscus tears present a vertically oriented tear pattern that can displace into the intercondylar notch and often coexist with anterior cruciate ligament injuries. A woman in her early forties with a 10-year history of recurrent knee pain, swelling, and mechanical locking and instability underwent diagnostic arthroscopy showing a triple bucket handle medial meniscus tear with complete ACL rupture. The patient received ACL reconstruction and triple bucket handle meniscus repair using multiple fixation techniques, plus lateral extra-articular tenodesis.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

Introduction

Relationship between meniscus tears and ACL injuries

Case Report

Clinical presentation and imaging

Surgical management and techniques

Conclusion

Keywords

Case Report Journal of Orthopaedic Case Reports 2025 December:15( 12) :Page 113-119 Restoring Stability –A Case ofa Decade Old Triple Bucket Handle Meniscus Tear with an Anterior Cruciate Ligament Injury: Case Report JerinJeevo1, Ashel DaphnyD’Souza1, Bibin Selvin1, Gaurav Kumar Gupta1, Velpula Mohan Babu1, Rajkumar SAmaravathi1 Learning Point of the Article: This case illustrates the surgical technique and follow-up of a patient with a decade old triple bucket handle medial meniscus tear with anterior cruciate ligament tear. Abstract Introduction: Bucket handle meniscus tears (BHMTs) represent a specific pattern of vertical tears wherein the displaced segment of themeniscus lodges into the intercondylar notch. These injuries often present with clinical symptoms including knee pain, intermittent locking, joint instability, swelling, and reduced range of motion. Bucket-handle meniscal tears are frequently observed in conjunction with anterior cruciate ligament (ACL) injuries, with reported incidences varying between 11% and 48%. Meniscus repair aims to alleviate symptoms and restore normal knee jointbiomechanics, allwhile maintaining the integrity of the native meniscus. To thebestofour knowledge, this case report is the first to document the fixation of a triple bucket handle tear of the medial meniscus, with clinical results and a 1-year post-operative assessment. Case Report: A woman in her early forties presented with a 10-year history of recurrent knee pain, swelling, and mechanical symptoms, worsened by a recent fall. Clinical evaluation revealed signsofACL deficiency and medial meniscal injury. Imaging confirmed a complex medial meniscus tearanda near-completeACL tear, with normal knee alignment on radiographsandscanogram. Diagnostic arthroscopy revealed triple BHMTwith completeACL tear. She underwent ACL reconstruction (ACLR) with peroneuslongus graft, triple bucket handle meniscus repair with all-inside, inside out and outside in technique, and lateral extra-articular tenodesis. Conclusion: Chronic triple bucket-handle meniscal tears present a complex surgical challenge. However, this case highlights that accurate anatomical reduction combined with stable fixation can lead to favorable post-operative outcomes, including improved knee function and enhanced quality of life. In addition, performing meniscal repair alongside ACLR increases the likelihood of successful healing and optimal functional recovery. Keywords: Knee injuries, meniscal tears, ligament rupture. Introduction Meniscus tears are associated with knee ligament injuries, including anterior cruciate ligament (ACL) injuries [1]. Various patterns of meniscal injuries are associated with both acute and chronic ACL tears, ranging from uncomplicated lesions to complex bucket-handle tears. Bucket-handle tears occur when a vertical longitudinal tear in themeniscus becomes displaced into the intercondylar notch, often resulting in clinical symptoms such as joint pain, instability, and mechanical locking [2] . Research suggests that acute ACL tears are more frequently |
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Website: [www.jocr.co.in](www.jocr.co.in)

DOI:
[https://doi.org/10.13107/jocr.2025.v15.i12.6472](https://doi.org/10.13107/jocr.2025.v15.i12.6472) | Author’s Photo Gallery | | | | | | | --- | --- | --- | --- | --- | --- | --- | | | | | |
Dr. Gaurav Kumar Gupta |
Dr. Velpula Mohan Babu |
Dr. Rajkumar SAmaravathi | | |
1Division of Arthroscopy, Sports Injury, Joint Preservation and Regenerative Medicine, St. John’s Medical College and Hospital, Bengaluru, Karnataka, India.
Address of Correspondence:
Dr. Rajkumar SAmaravathi,
Division of Arthroscopy, Sports Injury, Joint Preservation and Regenerative Medicine, St. John’s Medical College and Hospital, Bengaluru, Karnataka, India. E-mail: [rajkumar_as@yahoo.co.in](rajkumar_as@yahoo.co.in) | | | | | | | Submitted: 07/09/2025; Review: 19/10/20

FAQs

What defines a bucket handle meniscus tear and what symptoms can it cause?

A bucket handle meniscus tear is a vertically oriented tear where the displaced segment lodges into the intercondylar notch. It commonly presents with knee pain, intermittent locking, joint instability, swelling, and reduced range of motion.

Why are meniscus repair and ACL reconstruction performed together in this case?

The case emphasizes that restoring knee biomechanics and maintaining meniscal integrity are central goals. Meniscus repair is performed alongside ACL reconstruction to improve the likelihood of successful healing and functional recovery.

What surgical procedures were used to treat the triple bucket handle tear with ACL rupture?

The patient underwent ACL reconstruction using a peroneus longus graft, triple bucket handle meniscus repair using all-inside, inside-out, and outside-in techniques, and lateral extra-articular tenodesis.

Sep 29, 2026

Upload by hdkawk