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. 2025 Jan 30;20(1):115.
doi: 10.1186/s13018-025-05489-6.

Arthroscopic all-inside wrapping repair of lateral meniscus bucket-handle tears: clinical and imaging outcomes

Kun-Hui Chen  1   2   3 , Hsuan-Hsiao Ma  1   2 , Alisan Fu  1   4   5   6 , Hsin-Yi Wang  2   7 , Hsiao-Li Ma  1   2 , En-Rung Chiang  8   9   10
Affiliations

Arthroscopic all-inside wrapping repair of lateral meniscus bucket-handle tears: clinical and imaging outcomes

Kun-Hui Chen et al. J Orthop Surg Res. .

Abstract

Purpose: This study aimed to assess the clinical and radiographic healing rates of the arthroscopic all-inside wrapping repair technique for lateral meniscus bucket-handle tears (LMBHTs).

Methods: This retrospective study examined patients diagnosed with LMBHTs who underwent all-inside wrapping repair with or without anterior cruciate reconstruction between 2012 and 2021. Patients with previous knee surgeries, multiligamentous knee injuries, or advanced osteoarthritis were excluded. Clinical follow-up was at least 2 years. Clinical healing was defined as no reoperation of LMBHTs following initial repair and the absence of symptoms related to the LMBHT during follow-up. Postoperative clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score. At 6 months postoperatively, the healing of the repaired meniscus was evaluated using Henning's criteria through magnetic resonance imaging (MRI).

Results: Of the 34 patients included, two required re-operation for a re-tear of the BHT, resulting in a clinical healing rate of 94.1% (95% confidence interval [CI]: 82.9-99.2%) at a mean follow-up of 4.2 years. Among the remaining 32 patients, the mean postoperative IKDC score was 83.7 ± 8.2 (range, 70-95). MRI evaluations at 6 months postoperatively revealed complete healing in 64.7% (22/34; 95% CI: 47.9-79.5%), partial healing in 23.5% (8/34), and failure to heal in 12.5% (4/34, including the two re-tear cases). Subgroup analyses indicated no significant difference in the IKDC scores between patients with complete healing and those with partial healing on MRI (85.5 ± 7.9 vs. 82.3 ± 8.5; p = 0.53). Future studies with larger cohorts and stratified analyses are needed to explore potential predictors of healing outcomes.

Conclusions: The all-inside wrapping repair technique demonstrated favorable outcomes in patients with lateral BHTs and can be used as a viable alternative.

Keywords: All-inside wrapping repairn; Bucket-handle tear; Lateral meniscus repair.

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Conflict of interest statement

Declarations. IRB information: IRB approval has been obtained for this retrospective study. (IRB-TPEVGH No. 2023-04-011AC) Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
All-inside wrapping repair technique (a) A lateral meniscus bucket-handle tear of right knee seen in the intercondylar notch. (b) Temporary loops with Ethibond (green) and traction suture (blue). (c) Wrapping suture repair. (d) illustration of the All-inside wrapping repair. LFC, lateral femoral condyle; TP, tibia plateau; BHT, bucket-handle tear
Fig. 2
Fig. 2
Meniscus remodeling (a) Time zero after the all-inside wrapping suture technique. (b) Remodeling of repaired meniscus observed 3 years postoperatively, suture integration (arrow), and the meniscus regains its original triangular shape. TP, tibia plateau; LFC, lateral femoral condyle
Fig. 3
Fig. 3
Complete healing of a lateral meniscus bucket-handle tear (a) Sagittal MRI view reveals double anterior meniscus (blue arrow). (b) Coronal MRI view shows a fragment in the intercondylar notch (blue arrow). (c) Preoperative arthroscopic image of the lateral meniscus bucket-handle tear. (d) Postoperative arthroscopic image of the all-inside wrapping repair suture technique. (e) Sagittal MRI view reveals reduction and healing of the posterior lateral meniscus (red arrow). (f) Coronal MRI view shows reduction and healing of the lateral meniscus (red arrow). LFC, lateral femoral condyle; BHT, bucket-handle tear; TP, tibia plateau
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