Spontaneous Healing Of A Posteriorly Displaced Lateral Meniscus Bucket-handle Tear In A Multiligament Knee Injury: A Case Report
Green, J. S., Seddio, A. E., Roybal, D., Moran, J., Katz, L. D., & Medvecky, M. J. (2022). Spontaneous Healing of a Posteriorly Displaced Lateral Meniscus Bucket-Handle Tear in a Multiligament Knee Injury: A Case Report. JBJS case connector, 12(4), e22.00503. https://doi.org/10.2106/JBJS.CC.22.00503
View Original Source →Abstract
Case: Bucket-handle meniscus tears (BHMTs) typically involve the medial meniscus and often occur with concomitant rupture of the anterior cruciate ligament. We report an unusual case of a polytrauma patient who sustained a bicruciate multiligament knee injury (MLKI) with a posteriorly displaced lateral BHMT that spontaneously healed after reduction of the fragment. At the 2-year follow-up, the lateral meniscus was clinically stable without pain. Conclusion: A lateral BHMT with a posteriorly displaced fragment produced an atypical magnetic resonance imaging presentation in a bicruciate MLKI. Meniscal repair was aborted because of extravasation and concerns of compartment syndrome, but spontaneous healing occurred after fragment reduction.
Case Details
Disease Location
Knee
Personal Characteristics
19-year-old man
Clinical Characteristics
Brought by ambulance after a motorcycle accident. Initial radiographs confirmed closed midshaft fractures of the bilateral femurs and the left tibia. Underwent intermedullary (im) nailing of bilateral femurs and the left tibia and intraoperative fluoroscopic stress examination of the left knee, which displayed gross instability and high suspicion of cruciate ligament injury. One week later, the patient underwent planned diagnostic arthroscopy and repair of the lateral bucket-handle meniscal tear (bhmt) in the left knee. During arthroscopy, the lateral gutter showed disruption of the peripheral capsule where the lateral meniscus would sit. The acl was found to be completely avulsed off the tibia, and the posterior cruciate ligament was torn at the midsubstance. Fifteen minutes into the procedure, the calf began to show signs of fullness, which was concerning for intraoperative extravasation and possible acute compartment syndrome (acs). Therefore, the lateral meniscus was reduced back to its native position and the repair was aborted. The treatment plan was to return in 2 to 4 weeks. In the interim, the patient was placed in a knee immobilizer
Remission Characteristics
When the patient returned for arthroscopic repair 3 weeks later, there was near-complete attachment of the posterior horn of the lateral meniscus back to the capsule. When probed, there was 2 to 3 mm of meniscal translation and a firm end point. In addition, the patient had a grade 1 posterior drawer and grade 1b lachman, and the acl showed signs of healing back to the tibia.
Treatment & Mechanisms
Proposed Remission Mechanisms
It is possible that the combination of hematoma from the injury and surgical disruption of tissue within the joint space may have stimulated stem cells and growth factors to enhance healing
Clinical Treatment
Intramedullary nailing, arthroscopy, knee immobilizer