Revision Repair of a Locked Bucket-Handle Medial Meniscal Tear with Concomitant Anatomic Medial Collateral Ligament...

Bucket-handle medial meniscal (BHMM) tears are a complex injury commonly found in young athletes. The literature reports that, on average, 85% of BHMM repairs are successful 1 year postoperatively. When failure occurs, a revision repair is optimal to prevent long-term arthritic changes and further stress on other knee ligaments.

A revision repair of BHMM tears in adolescents is preferred compared with a meniscectomy due to a higher likelihood of the revision fully healing compared with older patients, and a higher chance of preventing the effects of increased joint contact stresses. The literature has reported that grade 3 medial collateral ligament (MCL) reconstructions may be indicated in symptomatic patients when medial compartment gapping exceeds 3 mm on stress x-rays.

A reconstruction of the superficial medial collateral ligament (sMCL) with a locked BHMM revision repair was performed. Dissection of significant scarring surrounding the semitendinosus and gracilis tendons was performed for graft harvesting. Tibial suture anchors were placed 6 cm distal to the joint line at the distal tibial attachment of the sMCL. A Beath pin was passed through the femoral sMCL attachment site anterolaterally, over reamed with a 7-mm reamer, and placed into the femoral tunnel with a passing suture. A medial meniscal retear was confirmed through arthroscopy. Twelve vertical mattress inside-out sutures were used to repair the BHMM tear. The sMCL graft was fixed with a slight varus force with the knee flexed to 20° in the femoral tunnel. Lastly, another suture anchor was placed at the proximal tibial sMCL attachment 15 mm distal to the joint line and sewn into the sMCL graft.

BHMM tears in the adolescent population have demonstrated a higher healing rate than similar tears in adults. Therefore, a revision BHMM tear repair is indicated, especially in the setting of a concomitant grade 3 sMCL tear.

One risk involved in BHMM tears and MCL reconstruction is damage to the posterior neurovascular structures. The technique presented attempts to restore the native contact pressures and biomechanics within the knee through a revision BHMM repair with an anatomic sMCL reconstruction.

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