Prognosis of Athletes After Meniscal Repair of Bucket Handle Tear
Athletes who undergo meniscal repair for bucket handle tears can expect a high rate of return to recreational sports, with significant improvements in functional outcomes, though failure rates vary between 14-69% depending on tear location and knee stability.
Return to Sport Outcomes
- The pooled postoperative Tegner score for athletes with isolated bucket handle meniscal tears undergoing surgical repair is 5.94 (95% CI: 5.41-6.46), indicating a high return to recreational sports 1
- 81% of elite athletes return to their main sport after meniscal repair, most at a similar level, with a mean return time of 10.4 months 2
- In long-term follow-up (mean 22.7 years), 85.3% of patients maintained the same level of sports activity or just one level below their pre-injury status after meniscectomy for bucket handle tears 3
Failure Rates and Risk Factors
- Medial meniscal bucket handle tear repairs have significantly higher failure rates (36.4%) compared to lateral meniscal repairs (5.6%) 2
- A recent study found a 69% failure rate for isolated bucket handle tear repairs of the medial meniscus in stable knees at a mean follow-up of 77.2 months 4
- The pooled failure rate across studies for bucket handle meniscal tears is approximately 14% (95% CI: 0-42%) 1
- Timing of surgery does not appear to be a significant prognostic factor for reoperation rates or postoperative outcomes in bucket handle meniscal tear repairs 5
Functional Outcomes
- Athletes with repaired bucket handle tears show significant improvements in Lysholm scores, with a mean improvement of 31.16 points (p = 0.0093) 1
- Long-term follow-up studies report mean IKDC scores of 85.4 and Lysholm scores of 89.6 after meniscal repair in elite athletes 2
- Even in cases where repair fails, 48.5% of patients report excellent global results and 38.2% report good global results in long-term follow-up 3
Return to Play Criteria
- Athletes should demonstrate full range of motion compared to the uninjured side, restored strength and proprioception, and ability to perform sport-specific movements without discomfort before returning to play 6
- A progressive, step-wise return to play protocol is recommended, beginning with light aerobic activities and advancing through sport-specific training without contact, non-contact team training, and finally full contact practice 6
- Each step of the return to play protocol should be completed without pain or swelling before advancing to the next level 6
Rehabilitation Considerations
- Neuromuscular training should be added to strength training to optimize self-reported outcome measurements and reduce risk of reinjury 7
- Rehabilitation after meniscal repair should be goal-based rather than strictly time-based, with specific functional criteria determining progression through phases 7
- Psychological factors such as self-efficacy, locus of control, and fear of reinjury influence the rehabilitation process and return to play 7
Long-Term Outcomes
- Despite high repair failure rates, meniscal repair attempts are still valuable as they often result in smaller subsequent meniscectomies than would have been performed initially 4
- With a mean Lequesne score of 2.38 at long-term follow-up (22.7 years), clinical osteoarthritis remains minimal after meniscectomy for bucket handle tears 3
- Radiological osteoarthritis is present in 57.7% of patients at long-term follow-up, but with minimal to moderate clinical impact 3
Common Pitfalls to Avoid
- Returning too early increases risk of re-injury or development of chronic instability 6
- Inadequate rehabilitation of proprioception and balance can lead to functional instability even with good healing 6
- Failure to address biomechanical issues that may have contributed to the initial injury can lead to poor outcomes 6