Treatment of Old Bucket-Handle Tear with Concomitant Anterior Cruciate Ligament Tear

Clinical Scenario

This protocol addresses the old bucket-handle meniscus tear occurring alongside a concomitant anterior cruciate ligament (ACL) tear — a combined injury that presents distinct management considerations compared to isolated meniscus pathology.

Why This Combination Matters

Meniscus repairs performed in the setting of an ACL-deficient, unstable knee carry a substantially higher failure rate. Isolated meniscus repair in this context should be avoided. When both an old bucket-handle tear and an ACL tear are present, current evidence supports addressing both pathologies together — ideally within the same surgical procedure — rather than staging them separately.

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.

Treatment Approach

When prior meniscus surgery has been attempted and meniscus-related complaints persist, a further surgical option may be considered. The complete sequence, indications, and decision criteria are detailed in the full protocol…

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References

DOI: 10.1007/s00167-020-05847-3

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.

Partial meniscus replacement may be considered for patients with failed meniscus surgeries and meniscus-related complaints.

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