Chronic Bicompartmental Bucket-Handle Meniscal Tears Associated With Anterior Cruciate Ligament (ACL) Rupture in an...

Bilateral bucket-handle meniscal tears (BHMTs) are uncommon, as these injuries are typically unilateral in a single knee and often associated with anterior cruciate ligament (ACL) tears. We present a rare case of a 36-year-old male with a history of intracerebral hemorrhage and epilepsy who developed chronic right knee pain, instability, and mechanical locking. MRI revealed ACL rupture and a displaced meniscal fragment. Arthroscopy confirmed bicompartmental BHMTs and ACL deficiency. Partial meniscectomy and debridement were performed. ACL reconstruction was not undertaken, as arthroscopy showed reattachment of the ligament, adequate graft tightness, and no clinical evidence of instability. ACL reconstruction was not performed due to adequate reattachment of the ACL. This case describes a rare presentation of chronic bicompartmental BHMTs with ACL rupture in a patient with underlying neurological deficits, where the neurological comorbidity likely masked symptoms and contributed to delayed seeking of medical care and delayed diagnosis. This case highlights the diagnostic challenges and therapeutic approach to bicompartmental bucket-handle tears in patients with chronic ACL deficiency and neurological comorbidity.