Bucket-handle meniscal tears in children under the age of 10: a literature review

Bucket-handle meniscal tears in children under the age of 10: a literature review


  • Gianluca Canton Orthopaedics and Traumatology Unit, Cattinara Hospital – ASUGI, Trieste (Italy)
  • Guido Maritan Orthopaedics and Traumatology Unit, Cattinara Hospital – ASUGI, Trieste (Italy)
  • Francesco Impellizzeri Orthopaedics and Traumatology Unit, Cattinara Hospital – ASUGI, Trieste (Italy)
  • Cristina Formentin Orthopaedics and Traumatology Unit, Cattinara Hospital – ASUGI, Trieste (Italy)
  • Luigi Murena Orthopaedics and Traumatology Unit, Cattinara Hospital – ASUGI, Trieste (Italy)


Knee, Bucket-handle meniscal tears, Children, Treatment


Background and aim of the work: Traumatic meniscal tears are raising in skeletally immature patients due to increasing participation in sport activities. Nonetheless, meniscal tears remain a rare injury in children, with a lack of evidence regarding treatment and outcome. The aim of the study is to review the literature on BHMT in children aged under 10 years.

Methods: Two independent reviewers conducted a systematic search of Embase, Medline and Pubmed databases to report a summary of literature evidence about epidemiology, clinical presentation, diagnosis, treatment and outcome of BHMTs in children under the age of 10.

Result:  Eight articles have been considered, including seven case reports and one case series. We found 21 cases of BHMTs in children under 10 years. The injury occurred in the medial meniscus in 8 cases (66,7%), while in 4 cases (33,3%) on a lateral discoid meniscus. The mean reported age is 4,6 years (range 2 years - 9 years), with prevalence of the female sex (62,5%).

Conclusion: BHMT is an uncommon lesion in children under 10 years old. It can be suspected after a history of knee trauma in patients with knee pain, effusion and locking. MRI is the best technique for the diagnosis. Current strategy of treatment is to preserve the meniscus through different arthroscopic suture techniques.


McConkey MO, Bonasia DE, Amendola A. Pediatric anterior cruciate ligament reconstruction. Curr Rev Musculoskelet Med 2011;4(2):37–44

Stanitski CL, Harvell JC, Fu F. Observations on acute knee

hemarthrosis in children and adolescents. J Pediatr Orthop.


Bellisari G, Samora W, Klingele K. Meniscus tears in children.

Sports Med Arthrosc Rev. 2011;19(1):50–5.

Carter CW, Kocher MS. Meniscus repair in children. Clin Sports

Med. 2012;31(1):135–54.

Ferrari MB, Murphy CP, Gomes JLE. Meniscus repair in children

and adolescents: a systematic review of treatment approaches,

meniscal healing, and outcomes. J Knee Surg. 2018.

Krych AJ, McIntosh AL, Voll AE, Stuart MJ, Dahm DL.

Arthroscopic repair of isolated meniscal tears in patients 18 years

and younger. Am J Sports Med. 2008;36(7):1283–9.

Lucas G, Accadbled F, Violas P, et all. Isolated

meniscal injuries in paediatric patients: outcomes after arthroscopic

repair. Orthop Traumatol Surg Res. 2015;101(2):173–7

Shea KG, Archibald-Seiffer N, Kim KM, Grimm NL. Bucket-handle meniscal tear in a 5-year-old child KNEE SURG SPORT TR A. 2012 ;20(11):2291-3

Kraus T, Heidari N, Švehlík M, Schneider F, et all. Outcome of repaired unstable meniscal tears in children and adolescents. Acta Orthop 2012; 83:261–266

Helms CA, Laorr A, Cannon WD Jr. The absent bow tie sign in bucket-handle tears of the menisci in the knee. Am J Roentgenol 1998; 170:57–61

Anas Nooh 1, Feras Waly, Fahad H Abduljabbar, Chantal Janelle; Bucket-handle meniscal tear in a 9-year-old girl: a case report and review of the literature 2015; J. Pediatr Orthop B, 2016

VOLK H, SMITH FM. Bucket-handle tear of the medial meniscus in a five-year old boy. J Bone Joint Surg Am. 1953 ;35-A(1):234-6

Saddawi ND, Hoffman BK. Tear of the attachment of a normal medial meniscus of the knee in a four-year-old-child. A case report. J Bone Joint Surg Am. 1970;52(4):809-11

Yalçin N, Bektaşer B, Ciçekli O, Doğan M. Alti yaşindaki kiz hastada diskoid lateral menisküsün kova sapi yirtiği [Bucket-handle tear of a discoid lateral meniscus in a 6-year-old girl]. Acta Orthop Traumatol Turc. 2009;43(6):528-31

Bloome DM, Blevins FT, Paletta GA Jr, et all. Meniscal repair in very young children. Arthroscopy. 2000;16(5):545-9

Fink K, Kaushal N, Gross J, Patel H, Delbello D. Bucket-Handle Tear of the Medial Meniscus in a 2-Year-Old Child. Orthopedics. 2018 Jul 1;41(4):e580-e582

Kramer DE, Kalish LA, Martin DJ, Yen YM, Kocher MS, Micheli LJ, Heyworth BE. Outcomes After the Operative Treatment of Bucket-Handle Meniscal Tears in Children and Adolescents. Orthop J Sports Med. 2019 Jan 15;7(1):2325967118820305.

Andrish JT. Meniscal Injuries in Children and Adolescents: Diagnosis and Management. J Am Acad Orthop Surg. 1996 Oct;4(5):231-237.

Hede A, Jensen DB, Blyme P, Sonne-Holm S. Epidemiology of meniscal lesions in the knee. 1,215 open operations in Copenhagen 1982-84. Acta Orthop Scand. 1990 Oct;61(5):435-7.

Mitchell J, Graham W, Best TM, Collins C, Currie DW, Comstock RD, Flanigan DC. Epidemiology of meniscal injuries in US high school athletes between 2007 and 2013. Knee Surg Sports Traumatol Arthrosc. 2016 Mar;24(3):715-22.

Shieh A, Bastrom T, Roocroft J, Edmonds EW, Pennock AT. Meniscus tear patterns in relation to skeletal immaturity: children versus adolescents. Am J Sports Med. 2013 Dec;41(12):2779-83.

Jackson T, Fabricant PD, Beck N, Storey E, Patel NM, Ganley TJ. Epidemiology, Injury Patterns, and Treatment of Meniscal Tears in Pediatric Patients: A 16-Year Experience of a Single Center. Orthop J Sports Med. 2019 Dec 20;7(12):2325967119890325.

Shakespeare DT, Rigby HS. The bucket-handle tear of the meniscus: a clinical and arthrographic study. J Bone Joint Surg Br. 1983;65: 383Y387

Kim JG, Han SW, Lee DH. Diagnosis and Treatment of Discoid Meniscus. Knee Surg Relat Res. 2016 Dec 1;28(4):255-262.

Goodman AD, Chase A, Owens BD. Locked Knee in a 15-Year-Old Girl: The Knee Examination. J Pediatr. 2017 Jun;185:245-245.e1.

Francavilla ML, Restrepo R, Zamora KW, Sarode V, Swirsky SM, Mintz D. Meniscal pathology in children: differences and similarities with the adult meniscus. Pediatr Radiol. 2014 Aug;44(8):910-25; quiz 907-9.

Takeda Y, Ikata T, Yoshida S, Takai H, Kashiwaguchi S. MRI high-signal intensity in the menisci of asymptomatic children. J Bone Joint Surg Br. 1998 May;80(3):463-7.

Magee TH, Hinson GW. MRI of meniscal bucket-handle tears. Skeletal Radiol 1998; 17:495-499.

Weiss KL, Morehouse HT, Levy IM. Sagittal MR images of the knee: a low signal band parallel to the posterior cruciate ligament caused by a displaced bucket handle tear. AJR Am J Roentgenol 1991; 156:117-119

Ververidis AN, Verettas DA, Kazakos KJ, et all. Meniscal bucket handle tears: a retrospective study of arthroscopy and the relation to MRI. KNEE SURG SPORT TR A, 2006; 14:343–349

Bui-Mansfield LT, DeWitt RM. Magnetic resonance imaging appearance of a double anterior cruciate ligament associated with a displaced tear of the lateral meniscus. J Comput Assist Tomogr 2006;30(2):327–332

Haramati N, Staron RB, Rubin S, Shreck EH, Feldman F, Kiernan H. The flipped meniscus sign. Skeletal Radiol 1993; 22:273–277

Brian W. Yang1 & Elizabeth S. Liotta1 & Nikolaos Paschos1. Outcomes of Meniscus Repair in Children and Adolescents. Curr. Rev. Musculoskelet. Med 2019

Dennis E. Kramer, Leslie A. Kalish, Daniel J. Martin et al. Outcomes After the Operative Treatment of Bucket-Handle Meniscal Tears in Children and Adolescents; Orthop J Sports Med. 2019

Yang BW, Liotta ES, Paschos N. Outcomes of Meniscus Repair in Children and Adolescents. Curr Rev Musculoskelet Med. 2019 Jun;12(2):233-238.




How to Cite

Canton G, Maritan G, Impellizzeri F, Formentin C, Murena L. Bucket-handle meniscal tears in children under the age of 10: a literature review . Acta Biomed [Internet]. 2021 Jul. 26 [cited 2024 Jul. 16];92(S3):e2021020. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/11742