Meniscal Repair Technique for Bicompartmental Displaced Bucket Handle Meniscal Tear in a Previously Reconstructed Anterior Cruciate Ligament: Trampoline-related Knee Injury – A Case Report

Introduction: Although bucket-handle meniscal tears are common injuries, simultaneous bicompartmental displaced bucket-handle tears involving both the medial and lateral menisci are exceedingly rare. This study highlights the challenges posed by bicompartmental bucket handle tears in terms of anatomical considerations and the technical challenges for repairing the menisci in a previously reconstructed anterior cruciate ligament (ACL) knee. Case Report: We report the case of a 31-year-old man who presented with acute knee pain during trampoline sports. The patient had undergone arthroscopic ACL reconstruction using a hamstring graft 2 years prior. On clinical examination, the patient had a knee range of motion of 10-90°, medial and lateral joint line tenderness, and positive McMurray tests for the medial and lateral menisci. Magnetic resonance imaging revealed bicompartmental displaced bucket handle tears and an ACL graft in situ with intact tunnels. Arthroscopic surgery was performed using a combination of all-inside and outside-in techniques to repair both tears. Outcomes: The patient underwent clinical examination at 1, 3, 6, and 12 months postoperatively. The patient achieved a knee flexion of up to 130° and hyperextension of 10° (same as the other knee) by the end of 2 months. The Lachman test after 2 months revealed no laxity of the ACL. The patient returned to unrestricted sports activity by 6 months postoperatively. At the 12-month follow-up, he remained symptom free, with a Lysholm score of 96. Conclusion: A hybrid surgical technique combining all-inside and outside-in methods allows successful management of complex bicompartmental meniscal tears, preserving meniscal function while minimizing surgical risks.Level of Evidence Level V, Expert Opinion/Case Report.