Volume 3 • Issue 1 • 1000126 Clin Med Case Rep, an open access journal Asiri et al., Clin Med Case Rep 2019, 3:1 Case Report Open Access Clinical and Medical Case Reports C l i n i c a l a n d M e d i c a l C a s e R e p o r t s *Corresponding author: Adel Al-Ahaidib, Departmentof Orthopedic Surgery, King Saud University, Riyadh, Saudi Arabia, Tel: +80-942317576; E-mail: alahaidib@hotmail.com Received April 02, 2019; Accepted April 30, 2019; Published May 09, 2019 Citation: Asiri FA, Al-Ahaidib A, Al-Ahaideb A (2019) A Bucket-Handle Tear in a Discoid Lateral Meniscus: A Case Report and Literature Review. Clin Med Case Rep 3: 126. Copyright: © 2019 Asiri FA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. A Bucket-Handle Tear in a Discoid Lateral Meniscus: A Case Report and Literature Review Faya A Asiri, Adel Al-Ahaidib* and Abdulaziz Al-Ahaideb Departmentof Orthopedic Surgery, King Saud University, Riyadh, Saudi Arabia Abstract Objective: Bucket-handle tears constitute about 10% of all meniscal tears. We aimed to report a case of a bucket-handle tear in a lateral discoid meniscus due to sports injury and to review the current pertaining literature. Case Report: A 32-year-old male presented with pain, intermittent swelling, clicking and locking symptoms of his right knee for 3 months following a twisting injury while playing football. On physical examination, there were neither effusion, redness, nor scars. He had tender medial and lateral joint lines with a full range of motion. Radiograph of the knee showed widened lateral joint space and medial joint space narrowing. MRI showed increased thickness and fattening of the lateral meniscus with loss of the natural bow-tie confguration refecting the presence of discoid meniscus. There was signal alteration within the meniscal substance extending across the entire lateral compartment indicating the presence of a tear. Diagnostic arthroscopy confrmed the presence of a bucket-handle tear in the discoid lateral meniscus. Partial meniscectomy with saucerization of the discoid lateral meniscus was performed. Postoperatively, early active range of motion with non-weight bearing mobilization was started. At 6 months postoperatively, the pain has resolved and he had no more locking or clicking symptoms. Conclusion: Satisfactory outcome of injured patients with a bucket-handle tear in a discoid meniscus can be obtained through arthroscopic partial meniscectomy with saucerization and early rehabilitation. Keywords: Bucket-handle; Meniscus tear; Discoid; Partial meniscectomy; Saucerization Introduction Te menisci are crescent-shaped structures made of fbrocartilage, which provide deepening for the articulation between the femoral and tibial articular surfaces. Te peripheral edge of menisci is thick and convex, while the inner edge is thin and concave. Each meniscus is connected to the proximal articular surface of the tibia by the anterior and posterior horns [1]. Te menisci work as a shock-absorber and distribute forces equally through the knee. Teir peripheral zones are vascularized from the fbrous capsule and synovial membrane, while the inner edges are avascular. Te medial menisci are C-shaped, broader posteriorly and semicircular in shape. Te lateral menisci are smaller and more freely movable than medial menisci and form four- ffhs of a circle [2,3]. Te menisci provide also neuromuscular control by the nerve endings embedded within their edges [4]. A discoid meniscus is an uncommon type of meniscus. Its incidence estimated from 0.4% to 17% for the lateral meniscus and 0.06% to 0.3% for the medial meniscus [5]. Discoid meniscus is thick and less vascular; compared to the normal menisci and their peripheral attachment is loose. Consequently, it is more liable to mechanical or shear stress, which may necessitate surgical management [6]. Watanabe et al. [7] described three types of discoid meniscus (complete, incomplete, and the Wrisberg-type). Te Wrisberg-type has a deformed posterior menisco-tibial attachment, so the meniscus is liable to anterior dislocation. Meniscal injury is a leading cause for the functional deterioration. Meniscal tears are the most common injuries to the knee. Traumatic meniscal tears are responsible for signifcant pain and loss of function. Infrequently, traumatic meniscal tears are bilateral [8]. Accurate diagnosis of a meniscal tear is important for reducing morbidity and achieving proper treatment. Meniscal damage alters the biomechanics across the knee joint by increasing axial and shear stresses, eventually leading to early degenerative osteoarthritis [9]. A discoid lateral meniscus is not an uncommon anomaly of a morphologically thickened meniscus [10,11]. Albeit a discoid lateral meniscus considered a pain generator e.g. ‘snapping knee syndrome’, symptoms primarily appear if a discoid lateral meniscus is injured [12,13]. Te discoid meniscus have been initially reported by Young in 1889, since then multiple reports followed through [14]. Nevertheless, most of the reports described only a narrow age group (mainly juvenile), unlike the situation in which we report this case in an adult patient [15,16]. For a long time, the menisci were managed as an inessential appendage and excised once started being symptomatic. However, as proved by long standing studies, meniscectomy per se is disappointing. A conservative approach for the meniscal tear management has been developed over the past few decades. Te importance of meniscal preservation has been emphasized, as it has been understood the role of menisci in weight bearing, stabilization, and energy absorption [17]. Nowadays, with our sound understanding of the meniscal function by biomechanical studies and advances in arthroscopic surgery, surgical management has dramatically changed. In general, arthroscopic partial meniscectomy or meniscal repair is acceptable based on clinical assessment of the tear. Recently, eforts are applied to study the replacement and/or regeneration of the meniscus in an efort to restore function [18]. Shifing toward meniscal preservation led us to new surgical techniques including meniscal transplant [19].