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Bucket handle menisc lesion
 The bucket handle menisc lesion is more frequent at the medial than at the lateral meniscus
(3-7x).
The first attack often occurs between 16-30 years old. Typical for this lesion is locking of the knee in flexion (after a flexion-rotation trauma), with possible manipulative unlocking (this treatment only gives temporary relief).
The examination shows :
a characteristic gait pattern: hopping on one leg, with the knee flexed and the heel raised
warmth, fluid
extension limited, with a springy block end-feel
tenderness of the coronary ligament.
Immediately after the injury, there is a non-capsular pattern, changing fairly quickly to the capsular pattern of the "fake" traumatic arthritis (i.e. post traumatic capsular reaction).
The treatment of choice is surgery.
In the meantime, a manipulation can alleviate some of the patient's problems. It may have to be repeated for some minutes and it is not always successful : I prefer to call it a "first aid manipulation". Experience shows that a recurrence is soon to be expected (even within a few hours).
Remark : instability after an ACL-lesion can cause a future menical lesion.
(See Part I, p128 ; Part II, p27)
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