Publication:

Meniscal preservation beyond 40 – outcomes of arthroscopic repair of chronic bucket-handle tears

This case series evaluated the outcomes of arthroscopic repair in five patients aged over 40 years with chronic medial bucket-handle meniscal tears, with a mean symptom duration of nine months. All patients demonstrated intraoperative adhesions (60% classified as major) along with grade 1 to 2 chondral changes. Despite attempted repair, a 100% failure rate was observed within 2 to 5 months, necessitating subsequent meniscectomy in all cases. Functional outcomes, as measured by the IKDC score, showed only modest improvement following repair (38.2%-54.0%), but improved substantially after meniscectomy (77.5% at one year; mean gain of 39.5%). Similarly, pain scores (VAS) demonstrated significant reduction only after meniscectomy (6.6-2.4). These findings suggest that in middle-aged patients with delayed presentation of chronic bucket-handle tears, the likelihood of repair failure is high, and primary or early meniscectomy may represent a more pragmatic treatment strategy.