Failure rates of repaired bucket-handle medial meniscus tears (BHMMTs) concomitant to ACL reconstruction are reported to be as high as 20%. The aim of this study was to evaluate failure rates of patients who underwent BHMMT repair using all-inside technique, suture hook+all-inside technique or suture hook+outside-in technique.

A retrospective analysis of patients diagnosed with a BHMMT who underwent meniscal repair during primary ACLR with a minimum follow-up of 2 years were eligible for the study. Patients were grouped based on the meniscal repair technique used; All-inside repair, suture hook+all-inside repair and suture hook+outside-in repair. At the end of the study period, secondary medial meniscectomy rates were determined.

The study population comprised 253 patients who underwent repair of a BHMMT with concomitant ACLR at a mean follow-up of 94.0±47.6 months. 114 patients (45.1%) underwent all-inside repair, 61 patients (24.1%) underwent suture hook+all-inside repair and 78 patients (30.8%) underwent suture hook+outside-in repair. Failure rates were 20.2%, 14.8% and 5.1% respectively (p=.0135). All-inside repairs were >4 times more likely to fail than those who underwent suture hook+outside-in repair (HR: 4.103; 95% CI, [1.369; 12.296], p=.0117). Failure was also 3 times higher (HR: 2.943; 95% CI; [1.224; 7.075] (p=.0159) for patients younger than 30 years of age compared with those aged 30 years or older. An additional anterolateral ligament reconstruction (ALLR) was also found to reduce the failure rate of repaired BHMMTs concomitant to ACLR.

Combined suture hook+outside-in repair of BHMMTS resulted in significantly fewer failures than all other techniques. Furthermore, patients under the age of 30 and those without an additional ALLR were associated with higher failure rates.