The treatment of bucket handle meniscus tear using “the pulling suture technique”: A new surgical technique

INTRODUCTION AND IMPORTANCE: Arthroscopic partial meniscectomy represents a challenge due to view obstruction by the tight posterior joint line. We are describing a new technique to overcome this obstacle using “the pulling suture technique” which is a simple, reproducible, and safe way to perform partial meniscectomy. CASE PRESENTATION: After a twisting knee injury, a 30-year-old man was complaining of left knee pain and locking. An irreparable complex bucket handle medial meniscus tear was found during diagnostic knee arthroscopy and partial meniscectomy was performed using the pulling suture technique. After visualizing medial knee compartment, a vicryl suture was introduce and looped around the torn fragment then secured by a sliding locking knot. The suture was pulled, and the torn fragment was placed under tension throughout the procedure to facilitate exposure and debridement of the tear. Then, the free fragment was extracted in one piece. DISCUSSION: Arthroscopic partial meniscectomy of the bucket-handle tears is a commonly performed procedure. Due to view obstruction, cutting of the posterior part of the tear is a challenging step. Any attempts of blind resection without proper visualization can lead to articular cartilage damage or insufficient debridement. In contrast to most described techniques to overcome this problem, the pulling suture technique doesn't require any accessory portals or additional equipments. CONCLUSION: Using “the pulling suture technique” improves resection by allowing a better view of both ends of the tear and securing the resected part by the suture, which facilitates its removal as a one unit.