Meniscal position after bucket-handle tear repair: A multiplanar MRI comparison of all-inside and inside-out techniques

Hypothesis/purpose: To compare multiplanar meniscal position following all-inside and inside-out repair of bucket-handle tears using magnetic resonance imaging (MRI) and to evaluate the associa tion between meniscal shift and short-term clinical outcomes. Methods: A retrospective comparative study was performed on 83 patients who underwent arthro scopic repair of bucket-handle meniscal tears. Postoperative MRI was used to evaluate meniscal position in multiple planes by measuring coronal extrusion and sagittal anterior and posterior meniscal position relative to the tibial plateau borders. When available, postoperative measurements were additionally compared with MRI findings from contralateral asymptomatic knees as a patient-specific native refer ence. Clinical outcomes were evaluated using Lysholm, International Knee Documentation Committee (IKDC), and visual analogue scale (VAS) scores at final follow-up. Comparisons were made between all inside and inside-out repair techniques. Results: Eighty-three patients were included (45 medial, 38 lateral). In the medial meniscus, coronal position did not change significantly after repair in either technique, whereas posterior sagittal position increased by approximately 2 mm after repair regardless of repair technique (both p < 0.001). In the lateral meniscus, the meniscus shifted toward a more peripheral coronal position postoperatively in both techniques (both p < 0.001), while posterior sagittal position increased by approximately 5 mm and anterior sagittal position remained unchanged. Postoperative meniscal position was comparable between techniques and generally remained within contralateral native reference ranges. All clinical scores improved significantly without technique-dependent differences. Conclusion: All-inside and inside-out repair produced comparable coronal and sagittal meniscal posi tion at 1 year after bucket-handle repair and similar clinical improvements. Postoperative meniscal position generally remained within contralateral reference ranges regardless of repair technique. No technique-dependent differences in meniscal position or clinical outcomes were identified.