Revision Repair of a Failed Bucket-Handle Medial Meniscal Tear Using Autologous Fibrin Clot Augmentation: A Case...

Meniscal preservation is increasingly favored because of the essential role of the meniscus in maintaining knee function and preventing early osteoarthritis. However, failure of primary meniscal repair remains a challenging clinical situation, and optimal revision strategies are not clearly established. Fibrin clot augmentation has been explored as a potential technique to enhance healing in revision meniscal repair. We report the case of a 30-year-old male who developed recurrent symptoms after arthroscopic repair of a bucket-handle tear of the medial meniscus. The patient initially sustained a twisting injury to the left knee and underwent arthroscopic meniscal repair in March 2025. Despite postoperative rehabilitation, he developed recurrent pain and mechanical symptoms in June 2025. Magnetic resonance imaging performed the same month suggested failure of the initial repair. Revision arthroscopy was subsequently performed on June 21, 2025, and revealed a persistent bucket-handle tear of the medial meniscus located in the red-white zone, consistent with failure of the previous repair. After refreshing the tear edges, an autologous fibrin clot prepared from 30 mL of peripheral venous blood was introduced arthroscopically into the lesion site. Meniscal repair was then completed using five outside-in sutures. At one-year follow-up, the patient reported complete resolution of pain, absence of locking episodes and instability, and successful return to work and sports activities. Clinical examination demonstrated a stable knee with full range of motion. The postoperative Lysholm score was 100/100, indicating an excellent functional outcome. This case highlights the potential value of autologous fibrin clot augmentation in revision meniscal repair and supports meniscal preservation as a viable treatment option after failure of primary repair of a bucket-handle medial meniscal tear. An excellent clinical outcome was observed at one-year follow-up, although structural healing could not be confirmed because postoperative MRI or second-look arthroscopy was not performed.