Future of 34 meniscectomies after bucket-handle meniscus tear: a retrospective study with a follow-up over 22 years

Abstract

After a bucket-handle meniscus tear, a partial meniscectomy by arthroscopy is recommended, when a meniscal suture is impossible. Short-term results of meniscectomy after bucket-handle meniscus tear, without cartilage or ligament additional injury, are mostly excellent: pain and blocking disappear, return to sports activities is possible. The aim of this retrospective study is to follow a partial meniscectomy evolution with a long follow-up between March 1990 and April 1994, and a senior surgeon operated 34 meniscectomies for bucket-handle meniscus tear by 34 patients (29 male and 5 female) with a mean age of 31.7 years (16-52 years) at time of surgery. The bucket-handle meniscus tear had a traumatic etiology on a knee with no cartilage lesion. The functional results were assessed by IKDC subjective score (International Knee Documentation Committee) and ARPEGE score (Association pour la Recherche et la Promotion de l'Etude du Genou). These scores were obtained by phone call questionnaire in March 2014 with a mean follow-up of 22.7 years (20-24 years). In this study, patients were reviewed and got a clinical examination to determine the Lequesne score, a radiological knee assessment according to Ahlbäck classification and a weight-bearing teleradiography. With an IKDC mean score of 85.8 after surgery, we observed that 29 patients go back to sports activities with the same level as before injury. The level of sports activity, with a regular practice after a mean follow-up of 22.7 years, was the same as immediately after surgery or just the level under for 85.3 % of patients. With ARPEGE score, 48.5 % of patients had a global excellent result and 38.2 % had a global good result after a long follow-up. With a mean Lequesne score of 2.38, osteoarthritis of knee is still clinical minimal after meniscectomy at long term. The score was worse after external meniscectomy (EM) than after an internal meniscectomy (IM). 57.7 % of patients have osteoarthritis on X-rays. In our study, functional results after partial meniscectomy for bucket-handle meniscus tear are similar than in the literature. More than half of our patients, reviewed after a long follow-up, had radiological osteoarthritis of knee with a variable clinical result, but often minimal to moderate, intensity modulated by the lower limb axis.

The Natural History of Meniscus Tears

“…3,4 Biomechanical studies have demonstrated decreased contact pressure distribution and increased load rates per area in knees after total meniscectomy, which are associated with the higher risk of degenerative changes seen in longitudinal population studies. 5,6,7 Meniscal tear rates are reported around 60 per 100,000, but with multiple studies demonstrating asymptomatic meniscal tears, the true incidence is likely grossly underestimated. 8,9 Males are more affected than females and a third of meniscal tears are associated with concomitant ligamentous injury, such as an anterior cruciate ligament rupture.…”

Arthroscopically Repaired Bucket-Handle Meniscus Tears: Patient Demographics, Postoperative Outcomes, and a Comparison of Success and Failure Cases

“…4 Successful repair is important to preserve joint kinematics and prevent progressive osteoarthritis in a typically young, athletic patient population. 8 Few case reports or clinical studies with limited cohort sizes of repair of bucket-handle meniscus tears exist in the literature, and limited studies clearly define the patient demographics and compare preoperative or intraoperative surgical variables in those with successful repair or failed repair. 4,[9][10][11][12][13][14] The purpose of this study was to evaluate a single academic institution's cohort of patients with buckethandle meniscus tears who underwent arthroscopic repair.…”

“…4 Successful repair is important to preserve joint kinematics and prevent progressive osteoarthritis in a typically young, athletic patient population. 8…”

Our Experience in Meniscus Tears and Differences in Sport Recovery between Medial and Lateral Partial Meniscectomy in Young Athlete

“…Finally, our sample is not homogeneous about practice sports and is not made up of professional sportsmen. Therefore, the differences in athletic level and rehabilitation intensity could affect recovery time [19][20][21][22][23][24].…”