Red-White Zone Involvement and Medial Meniscal Tears Are Associated with Poorer Prognosis after Arthroscopic Repair of Bucket-Handle Tears

Background: Arthroscopic repair of bucket-handle meniscal tears (BHMTs) is technically challenging owing to the complexity of the tear patterns.Compared to simpler meniscal tears, BHMTs are associated with a higher failure rate and often require subsequent meniscectomy.This study aimed to assess clinical outcomes, failure rates, and risk factors for failure following primary arthroscopic repair of BHMTs.Methods: Seventy-four patients (mean age, 27.2 ± 11.2 years) who underwent arthroscopic BHMT repair were included (mean follow-up period, 60.2 ± 36.0 months).Analyzed risk factors included age, sex, body mass index, chronicity, laterality, tear zone, and concomitant anterior cruciate ligament reconstruction.Clinical failure was defined as the presence of clinical symptoms consistent with a meniscus tear and the need for subsequent surgery.The Kaplan-Meier method and log-rank test were performed to compare groups classified by postoperative meniscal healing status on magnetic resonance imaging (MRI) at a mean follow-up period of 7.30 ± 1.80 months.Clinical outcomes were assessed using the Tegner activity score, Lysholm knee score, and Hospital for Special Surgery (HSS) knee score.Results: The clinical failure rate was 14.9% (11 / 74).Six patients underwent subtotal meniscectomy, and 5 patients underwent partial meniscectomy.Red-white zone involvement was a significant risk factor for clinical failure (odds ratio, 6.182; 95% CI, 1.093-34.950;p = 0.039).Survival analysis based on postoperative MRI findings revealed a significant difference among 3 groups (p = 0.008): the completely healed group showed a 100% survival rate (20 / 20); the partially healed group, 80% (32 / 40); and the unhealed group, 0% (0 / 5).Patients with lateral BHMTs had a significantly higher rate of complete healing than those with medial BHMTs (46.4% vs. 18.9%; p = 0.014).At the final follow-up, the non-failure group demonstrated significantly higher Tegner activity (5.1 ± 1.2 vs. 4.4 ± 0.5; p = 0.038), Lysholm knee (87.7 ± 6.2 vs. 83.2± 3.1; p = 0.029), and HSS knee (93.9 ± 4.7 vs. 89.6 ± 3.0; p = 0.007) scores than the failure group.Conclusions: BHMTs involving the red-white zone or located in the medial meniscus-particularly those showing inferior early postoperative MRI healing-should be closely monitored after surgery.