Objective: To summarize the clinical features, surgical methods, and prognosis of bucket-handle meniscal tears (BHMTs), and provide guidance for clinical treatment.
Methods: The clinical data of 91 BHMTs patients (91 knees), who met the selection criteria and were admitted between January 2015 and January 2021, was retrospectively analyzed. There were 68 males and 23 females. Age ranged from 16 to 58 years with an average of 34.4 years. The injury was caused by sports in 68 cases, traffic accident in 15 cases, and falls or sprains in 8 cases. There were 49 cases of left knee injury and 42 cases of right knee injury. The time from the onset of symptoms to the admission ranged from 1 day to 13 months (median, 18 days), including >1 month in 35 cases and ≤1 month in 56 cases. Medial BHMTs occurred in 52 cases and lateral BHMTs in 39 cases. There were 36 cases with ACL rupture and 12 cases with discoid meniscus. The knee extension was limited more than 10° in 55 cases. According to the condition of meniscus injury, the meniscus suture with Inside-out combined with All-inside techniques (54 cases) or meniscoplasty (37 cases) under arthroscopy were selected. ACL reconstruction was performed in all patients with ACL rupture with autogenous hamstring tendon. Postoperative complications were observed. International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner score were used to evaluate knee function, and clinical failure was recorded.
Results: Two patients developed intermuscular venous thrombosis, which improved after oral anticoagulant therapy. No vascular injury, postoperative infection, joint stiffness, or other complications occurred in all patients. All patients were followed up 24-95 months, with a median of 64 months. A total of 12 cases (13.19%) failed the operation and were re-operated or given oral anti-inflammatory analgesics and rehabilitation therapy. At last follow-up, IKDC score and Lysholm score of 91 patients significantly increased when compared with those before operation ( P<0.05), while Tegner score significantly decreased ( P<0.05). The above indexes of patients treated with meniscus suture and meniscoplasty were also significantly different from those before operation ( P<0.05).
Conclusion: BHMTs occurs mostly in young men and is one of the important reasons for the limitation of knee extension after trauma. Arthroscopic meniscus suture and meniscoplasty can obtain good effectiveness according to individual conditions of patients. But the latter can better preserve the shape and function of meniscus, and theoretically can obtain better long-term outcomes, which needs to be confirmed by further research with larger sample size.
目的: 总结半月板桶柄样撕裂（bucket-handle meniscal tears，BHMTs）患者临床特征以及手术方式选择、预后，为临床治疗提供参考。.
方法: 回顾分析2015年1月—2021年1月收治且符合选择标准的91例BHMTs患者（91膝）临床资料。男68例，女23例；年龄16～58岁，平均34.4岁。致伤原因： 运动损伤68例，交通事故伤15例，摔伤或扭伤8例。损伤侧别：左膝49例，右膝42例。患者出现症状至就诊时间为1 d～13个月，中位时间18 d；其中>1个月35例、≤1个月56例。BHMTs发生于内侧52例、外侧39例。55例膝关节伸直受限>10°。合并ACL断裂36例，盘状半月板12例。根据半月板损伤情况，选择于关节镜下Inside-out技术联合All-inside技术半月板缝合术（54例）或半月板成形术（37例），合并ACL断裂者均行自体腘绳肌腱重建。术后观察并发症发生情况，采用国际膝关节文献委员会（IKDC）评分、Lysholm评分、Tegner评分评价膝关节功能，记录手术临床失败发生情况。.
结果: 术后2例半月板缝合术患者出现下肢肌间静脉血栓形成，给予口服抗凝治疗后好转。所有患者无血管损伤、感染、关节僵硬等并发症发生。患者均获随访，随访时间24～95个月，中位时间64个月。随访期间12例（13.19%）手术临床失败，给予再次手术或对症保守治疗。末次随访时，91例患者IKDC评分、Lysholm评分均较术前提高，Tegner评分较术前下降，差异均有统计学意义（ P<0.05）；半月板缝合术及成形术患者上述指标与术前差异亦有统计学意义（ P<0.05）。.
结论: BHMTs是外伤后膝关节伸直受限的重要原因之一，多发生于青年男性。根据患者个体情况选择关节镜下半月板成形术或缝合术，均可获得较好疗效。但后者可以更好地保留半月板形态和功能，理论上可获得更好远期疗效，但有待进一步扩大样本量、延长随访时间比较明确。.
Keywords: All-inside technique; Bucket-handle meniscal tear; Inside-out technique; meniscoplasty; meniscus suture.