Red-White Zone Involvement and Medial Meniscal Tears Are Associated with Poorer Prognosis after Arthroscopic Repair of Bucket-Handle Tears
- Author:
Bo Seung BAE
1
;
Jung Suk KIM
;
Sang Hak LEE
Author Information
- Publication Type:Original Article
- From:Clinics in Orthopedic Surgery 2026;18(1):40-51
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:Arthroscopic repair of bucket-handle meniscal tears (BHMTs) is technically challenging owing to the complexity of the tear patterns. Compared to simpler meniscal tears, BHMTs are associated with a higher failure rate and often require subsequent meniscectomy. This study aimed to assess clinical outcomes, failure rates, and risk factors for failure following primary arthroscopic repair of BHMTs.
Methods:Seventy-four patients (mean age, 27.2 ± 11.2 years) who underwent arthroscopic BHMT repair were included (mean follow-up period, 60.2 ± 36.0 months). Analyzed risk factors included age, sex, body mass index, chronicity, laterality, tear zone, and concomitant anterior cruciate ligament reconstruction. Clinical failure was defined as the presence of clinical symptoms consistent with a meniscus tear and the need for subsequent surgery. The Kaplan-Meier method and log-rank test were performed to compare groups classified by postoperative meniscal healing status on magnetic resonance imaging (MRI) at a mean follow-up period of 7.30 ± 1.80 months. Clinical outcomes were assessed using the Tegner activity score, Lysholm knee score, and Hospital for Special Surgery (HSS) knee score.
Results:The clinical failure rate was 14.9% (11 / 74). Six patients underwent subtotal meniscectomy, and 5 patients underwent partial meniscectomy. Red-white zone involvement was a significant risk factor for clinical failure (odds ratio, 6.182; 95% CI, 1.093–34.950; p = 0.039). Survival analysis based on postoperative MRI findings revealed a significant difference among 3 groups (p = 0.008): the completely healed group showed a 100% survival rate (20 / 20); the partially healed group, 80% (32 / 40); and the unhealed group, 0% (0 / 5). Patients with lateral BHMTs had a significantly higher rate of complete healing than those with medial BHMTs (46.4% vs. 18.9%; p = 0.014). At the final follow-up, the non-failure group demonstrated significantly higher Tegner activity (5.1 ± 1.2 vs. 4.4 ± 0.5; p = 0.038), Lysholm knee (87.7 ± 6.2 vs. 83.2 ± 3.1; p = 0.029), and HSS knee (93.9 ± 4.7 vs. 89.6 ± 3.0; p = 0.007) scores than the failure group.
Conclusions:BHMTs involving the red-white zone or located in the medial meniscus—particularly those showing inferior early postoperative MRI healing—should be closely monitored after surgery.
