What is a bucket handle tear?

A bucket handle tear is a type of meniscus tear that affects your knee. According to the journal Arthroscopy Techniques, an estimated 10 percent of all meniscal tears are bucket handle tears. These meniscus tear types most commonly affect young men. While there are several different types of meniscus tears, the bucket handle tear is traditionally more difficult (but definitely not impossible) to treat.

You have two menisci in your knee: medial and lateral. Your medial meniscus is C-shaped and protects the inside portion of your knee. Your lateral meniscus is U-shaped and rests on the outer half of your knee joint. Each meniscus helps reduce the overall pressure on your knee joint. However, menisci are subject to tear.

A bucket handle tear is a full-thickness tear of the meniscus that most often happens in the inner portion of your medial meniscus. According to the Wheeless’ Textbook of Orthopaedics, bucket handle tears occur three times more often in the medial meniscus than the lateral one. The name “bucket handle” refers to how a portion of the meniscus tears and can flip over like the handle on a bucket. Sometimes, a torn meniscus portion may flip over and become stuck in the knee joint.

The chief symptom of a meniscal tear is pain and discomfort. Sometimes the pain may be generalized to your knee or along each edge of your knee joint. The other symptom that often accompanies a bucket handle tear specifically is a locked knee joint. This occurs when your joint will not fully straighten after it’s bent.

Other symptoms you may experience with a bucket handle tear include:

  • stiffness
  • tightness
  • swelling

Bucket handle tears also often accompany an anterior cruciate ligament (ACL) tear. Some of the symptoms that could indicate an ACL tear include:

  • difficulty bearing weight on the knee
  • knee instability
  • popping sensation when moving the knee
  • severe pain

Both conditions require a doctor’s treatment to aid in recovery and return to mobility.

While you can experience a meniscal and bucket handle tear at any age, they most commonly occur in younger people who take part in regular athletic activity. Meniscal tears are most commonly due to twisting injuries, such as planting the knee and foot down forcefully and changing weight or turning too quickly. The meniscus typically starts to weaken when you’re in your 30s, making people this age and older more vulnerable to injury.

Other ways you can experience a bucket handle tear include:

  • climbing stairs
  • squatting
  • taking a misstep when walking and twisting the knee

Sometimes, you can have a chronic bucket handle tear due to degenerative changes in your knee joint. When arthritis causes the bones of your knee joint to rub against each other, areas can become irregular and rough instead of smooth. These changes make it easier for a bucket handle tear to occur.

If you hear a distinct pop while exercising, or experience pain, swelling, or locking of the knee, you should see your doctor. They will ask about your symptoms and they may recommend imaging studies. This often includes a magnetic resonance imaging (MRI) scan. Your doctor can often identify a bucket handle tear because it has a distinct “double PCL” sign, where the posterior cruciate ligament (PCL) looks doubled because of the meniscus injury.

Doctors typically recommend surgery to repair a bucket handle tear, with a few exceptions. First, if you have a chronic bucket handle tear that doesn’t cause symptoms, your doctor will not usually recommend surgery. Second, if you have a history of severe arthritis (such as grade 3 or grade 4 arthritis), a bucket handle tear repair may not relieve your symptoms.

Conservative treatment and time may be the best course of action, especially in the case of a minor tear, or depending on where, in the meniscus, your injury is. This means rest, regular icing, and likely taking nonsteroidal anti-inflammatory medication as your knee heals.

Another treatment which some doctors have used for meniscal tears is platelet rich plasma (PRP) therapy. This is a nonsurgical treatment method. One case study reported “spontaneous healing” of a bucket handle tear in a 43-year-old man after three PRP injection treatments. While promising, results may not always be this conclusive. Researchers are continuing to explore nonsurgical options like this.

Surgical options

Ideally, a doctor will be able to surgically repair your torn meniscus. They usually do this through knee arthroscopy. This involves making small incisions and inserting instruments into the incisions to access the knee joint and repair the damaged area. They’ll sew the damaged parts back together, if possible.

Sometimes, a doctor can’t repair the damage. In this case, they’ll remove the affected portion. While this can reduce immediate symptoms, you may be more vulnerable to early osteoarthritis.

After surgery, a doctor will typically recommend that you don’t bear weight on your affected leg for about six weeks. You might walk with crutches and wear a special brace called a knee immobilizer to allow for healing time. People are usually encouraged to participate in physical therapy or engage in physical therapy exercises, such as passive range of motion exercises.

According to the journal Arthroscopy Techniques, most people return to sports and other physical activities about four to five months after surgery.

Because most bucket handle tears occur in young, healthy individuals, surgical repairs can help keep you active and pain-free. While recovery can take several months, you can often return to your full physical activities with time and physical therapy exercises.