Clin Orthop Surg.  2012 Jun;4(2):129-133. 10.4055/cios.2012.4.2.129.

Intra-articular Patterns of Bucket Handle Meniscal Tears and Its Relation to Reducibility

• Lim HC
• Bae JH
• Kim TS
• Yang JH
• Park SC
• Yoon JR

• KMID: 1383874
• DOI: http://doi.org/10.4055/cios.2012.4.2.129

Abstract

BACKGROUND
The purpose of this study was to assess the intra-articular patterns in the rotational deformities of bucket handle meniscal tears (BHMTs) based on arthroscopic findings and their clinical relevance.
METHODS
From 2004 to 2009, 42 patients with a BHMT diagnosed by magnetic resonance imaging underwent arthroscopic surgery. The arthroscopic data (all procedures were recorded) were evaluated retrospectively, and BHMTs were classified according to the rotational directions of centrally displaced fragments. To assess the reliability of the agreement in this classification, 2 orthopedic surgeons re-classified BHMTs, 1 week after first trial. Intra- and interobserver reliabilities were assessed using kappa statistics. In addition, we address specific tear patterns, associated anterior cruciate ligament injury, medio-lateral difference, reducibility, chronicity, and reparability.
RESULTS
Most of the tears could be categorized into one of 3 morphologic patterns. Of the tears, 4.8% could not be categorized. BHMTs were classified, based on the rotational directions of centrally displaced fragments, as follows; the upward rotation group (type 1), the downward rotation group (type 2) and the reverse group (type 3). The most common intra-articular pattern was type 1 (29 patients, 69%). The occurrence of the other patterns was: type 2 in 7 patients (16.7%), type 3 in 4 patients (9.5%); we were not able to make a classification of type in 2 patients (4.8%). Intra-observer reliability was 0.86 in terms of kappa statistics, which implies almost perfect agreement. Mean interobserver reliability (0.73) showed substantial agreement. Type 1 and 2 tears were easily reduced, whereas all type 3 tears (4/4) needed additional procedures to achieve reduction.
CONCLUSIONS
Based on arthroscopic findings, we describe a comprehensive BHMT classification scheme that encompasses 95.2% of all tears. Tear type was correlated with reducibility.

Keyword

Bucket handle meniscal tear; Intra-articular pattern; Knee; Menisci; Arthroscopy

MeSH Terms

Adolescent
Adult
Anterior Cruciate Ligament/*injuries/pathology/surgery
Arthroscopy/*methods
Female
Humans
Knee Injuries/classification/*pathology/surgery
Magnetic Resonance Imaging
Male
Menisci, Tibial/*injuries/pathology/surgery
Middle Aged
Reproducibility of Results
Retrospective Studies

Figure

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  Fig. 1 (A) The two-dimensional figure of "upward rotation" of the displaced fragment (type 1), (B) in arthroscopy.

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  Fig. 2 (A) The two-dimensional figure of "downward rotation" of the displaced fragment (type 2), (B) in arthroscopy.

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  Fig. 3 (A) The two-dimensional figure of the flipped fragment in which the central sharp margin of the meniscus faces the peripheral side (type 3), (B) before reduction and (C) during reduction.

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  Fig. 4 In type 1 tears, (A) the tibial surface of displaced fragments was deformed in arthroscopy, (B) showing irregular surface grossly.

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