A 22-year-old badminton player presents with medial knee pain after a twisting injury. McMurray's test is positive for the medial meniscus. MRI confirms a bucket-handle tear of the medial meniscus with a displaced fragment in the intercondylar notch. The patient has a locked knee with a 15° flexion block. What is the most appropriate management?

• A Conservative management with physiotherapy; tears often heal spontaneously
• B MRI-guided aspiration of the locked fragment under ultrasound
• C Total knee replacement as the meniscus is irreparably damaged
• D Emergency (urgent) arthroscopic reduction and meniscal repair or partial meniscectomy to unlock the knee ✓

Explanation

A displaced bucket-handle meniscal tear causing mechanical locking with a flexion block is an urgent/semi-urgent arthroscopic indication. The displaced fragment causes mechanical block to full extension/flexion and risks further articular cartilage damage. Arthroscopic management involves: reduction of the displaced bucket handle and repair if the tear is in the vascular zone (peripheral red-red or red-white zone, acute tear in young patient) or partial meniscectomy if the tear is in the avascular zone or irreparable. Meniscal repair in young active patients preserves meniscal function and protects the joint long-term. Conservative management is not appropriate for a locked knee with a mechanical block.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.