Restoring Stability – A Case of a Decade Old Triple Bucket Handle Meniscus Tear with an Anterior Cruciate Ligament Injury: Case Report

Introduction: Bucket handle meniscus tears (BHMTs) represent a specific pattern of vertical tears wherein the displaced segment of the meniscus lodges into the intercondylar notch. These injuries often present with clinical symptoms including knee pain, intermittent locking, joint instability, swelling, and reduced range of motion. Bucket-handle meniscal tears are frequently observed in conjunction with anterior cruciate ligament (ACL) injuries, with reported incidences varying between 11% and 48%. Meniscus repair aims to alleviate symptoms and restore normal knee joint biomechanics, all while maintaining the integrity of the native meniscus. To the best of our knowledge, this case report is the first to document the fixation of a triple bucket handle tear of the medial meniscus, with clinical results and a 1-year post-operative assessment. Case Report: A woman in her early forties presented with a 10-year history of recurrent knee pain, swelling, and mechanical symptoms, worsened by a recent fall. Clinical evaluation revealed signs of ACL deficiency and medial meniscal injury. Imaging confirmed a complex medial meniscus tear and a near-complete ACL tear, with normal knee alignment on radiographs and scanogram. Diagnostic arthroscopy revealed triple BHMT with complete ACL tear. She underwent ACL reconstruction (ACLR) with peroneus longus graft, triple bucket handle meniscus repair with all-inside, inside out and outside in technique, and lateral extra-articular tenodesis. Conclusion: Chronic triple bucket-handle meniscal tears present a complex surgical challenge. However, this case highlights that accurate anatomical reduction combined with stable fixation can lead to favorable post-operative outcomes, including improved knee function and enhanced quality of life. In addition, performing meniscal repair alongside ACLR increases the likelihood of successful healing and optimal functional recovery.