This protocol addresses the management of an old bucket-handle meniscus tear occurring alongside a concomitant anterior cruciate ligament (ACL) tear — a combined injury that presents distinct surgical considerations compared to isolated meniscus pathology.
An ACL-deficient knee is an unstable environment. Performing meniscus repair in isolation under these conditions carries a high failure rate. Ideally, both pathologies are addressed during the same surgery to optimise meniscus healing outcomes.
When both an old bucket-handle tear and an ACL injury are present, the preferred approach involves addressing both structures arthroscopically in a single operative session. Meniscus repairs performed alongside ACL reconstruction show higher healing rates than isolated repair in the unstable knee.
The complete operative protocol — including technique selection, sequencing, and follow-up criteria — is available in the full structured regimen.
The primary clinical target is meniscus healing, assessed by the treating surgeon following the procedure.
Isolated meniscus repairs in unstable knees, such as an ACL-deficient knee, should be avoided because of their high failure rate.
Ideally, both pathologies are addressed during the same surgery.
In a noninflammatory knee with an ACL injury that occurred several weeks or more ago and an acute, nonreducible bucket handle meniscus tear, the preferred treatment is the prompt repair of the meniscus and the simultaneous reconstruction of the ACL.
Additionally, meniscus repairs performed with concomitant ACL reconstruction show a higher healing rate.
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