Large Meniscocapsular Separation: Diagnosis and Treatment. A Case Series.

Purpose: To highlight a special entity of meniscal injuries – “large meniscocapsular separation”, involving more than 20 mm of the meniscus-capsule junction, stressing that they present as bucket-handle tear. This study reports diagnosis of large meniscocapsular tears and functional outcomes after suture repair. Methods: This retrospective study included five males with large meniscocapsular separation treated between January 2012 and December 2013. All were involved in sporting trauma. Average age was 28.4 years. All cases had a minimum 2-years follow-up, average (28.2 months). All cases had an M.R.I. There were 3 medial and two lateral meniscal tears. During arthroscopy, complete separation of the meniscus at the capsular junction was reported, with displacement into the notch in all cases. Reduction was done followed by using the shaver for edge abrasion. An outside-in suture technique had been used to repair the meniscus, using 4 horizontal sutures. The Lysholm knee score was recorded to assess functional outcome, and had been recorded before surgery, 6 months after surgery and at final follow-up. Results: Full range of motion was gradually restored. Minimal tenderness was noticed at site of sutures. Four patients had returned to pre-injury activity level. Lysholm knee score improved from a mean of 37.6 (range 20-61) preoperatively to 82.8 (range 78-89) at 6 months, then to 86.6 (range 79-94) at final follow-up. Conclusion: Large meniscocapsular separation presents as a bucket-handle tear. Vigorous twisting and locking should raise suspicion. M.R.I. may be misleading. Reduction and multiple suture placement from posterior to anterior allows healing and prevents further displacement. Level of Evidence: Level IV, therapeutic case series.