Medial and Lateral Meniscus Bucket Handle Tears: A Comprehensive Review

Bucket-handle tears represent a distinct and clinically significant subgroup of meniscal injuries characterized by displacement of a longitudinally torn meniscal fragment into the intercondylar notch. These lesions commonly produce mechanical symptoms, including knee locking, restricted range of motion (ROM), and acute functional impairment, often necessitating prompt surgical intervention. Although medial bucket-handle tears are encountered more frequently, lateral bucket handle tears pose unique diagnostic and therapeutic challenges because of their stronger association with acute trauma and anterior cruciate ligament injuries. Accurate diagnosis relies heavily on magnetic resonance imaging (MRI), where classic findings such as the double posterior cruciate ligament sign, absent bow-tie sign, and fragment-in-notch sign facilitate detection. Current treatment strategies emphasize meniscal preservation through repair rather than meniscectomy, given the critical role of the meniscus in load transmission, joint stability, and long-term cartilage preservation. Surgical decision-making should consider tear chronicity, reducibility, tissue quality, vascular zone involvement, and concomitant procedures such as anterior cruciate ligament reconstruction. Differences between medial and lateral bucket-handle tears influence repair techniques, healing potential, and postoperative rehabilitation protocols. This comprehensive review summarizes the current evidence regarding the epidemiology, pathomechanics, clinical presentation, imaging characteristics, treatment strategies, and outcomes of medial and lateral bucket-handle meniscal tears. By emphasizing the anatomical and biomechanical distinctions between these entities, this review aims to provide a practical framework for optimized diagnosis, individualized treatment planning, and improved clinical outcomes in patients with bucket-handle meniscal injuries.