How I Repair a Bucket Handle Meniscus Tear
In this video, I walk you through a real case: a meniscus repair for one of the more serious tear patterns I see — a bucket handle meniscus tear.
What made this tear different
On the MRI, the tear pattern was clear. A large fragment of the meniscus had flipped inward on itself, like the handle of a bucket lifting away from its base — hence the name. Because this displaced fragment was sitting where it shouldn't be, my patient couldn't fully straighten his knee. That's a hallmark of this injury: the flipped fragment physically blocks the joint from extending, so the knee feels — and behaves — as if it's locked.
Going in
I start by putting a camera into the knee joint through small keyhole incisions — this is arthroscopy. This lets me confirm exactly what the MRI suggested: the tear, and the displaced fragment sitting out of place.
Reducing the tear
Before any repair can happen, the flipped fragment has to be put back where it belongs. Using specialised instruments, I reduce the tear — carefully manoeuvring the displaced piece of meniscus back into its normal anatomical position.
Repairing the meniscus — two techniques
Once the fragment is reduced, the repair itself typically calls on two complementary techniques:
All-inside repair — using a specialised device, I secure the torn meniscus back to the capsule from within the joint. This is a precise, suture-based fixation entirely through the keyhole incisions.
Inside-out repair — for other parts of the tear, I use sharp needles passed from inside the joint to outside, giving strong, reliable fixation in areas the all-inside technique doesn't reach as well.
Using both techniques together lets me tailor the repair to the exact tear pattern, rather than forcing one method to do a job it isn't best suited for.
The outcome
The before-and-after photos tell the story simply: a torn, flipped meniscus, restored to its normal position and secured. After surgery, my patient was able to fully extend his knee again — the mechanical block was gone.
A bucket handle tear looks alarming on a scan, and understandably worries patients when they're told their meniscus is "flipped." But with the right technique, most of these tears are repairable rather than something to simply trim away — and repairing rather than removing meniscus tissue matters for the knee's long-term health.
Restoration, not just removal, is the goal every time I go into a knee.
If you have any questions about this surgery or your own MRI findings, feel free to reach out.