Meniscal Bucket-Handle Tears and Return to Sports in Young Adults: A Systematic Review and Meta-Analysis.

Bucket-handle tears represent a subtype of meniscal injuries that involve a full-thickness longitudinal tear. These tears are challenging and demanding. The present systematic review and meta-analysis aimed to evaluate return-to-sport outcomes in young adults with isolated bucket-handle meniscal tears treated surgically through meniscal repair. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with two independent reviewers selecting studies from PubMed, Web of Science, and Scopus databases. Studies were included if they involved patients over 16 years old, with isolated bucket-handle tears, a minimum of one-year follow-up, and reported postoperative Tegner scores. Five studies comprising 168 individual knees met these criteria and were analyzed. Quality assessment employed the Newcastle-Ottawa Scale. Data analysis was conducted in R (R Foundation for Statistical Computing, Vienna, Austria) for pooled outcome calculations. The primary outcome was the postoperative Tegner score, representing a return to sports; secondary outcomes included changes in Tegner and Lysholm scores and failure rates. Two cohort studies and three case series were included, with quality ratings ranging from fair to poor. The mean patient age was 27.8 years, and the mean follow-up was 82.4 months. The pooled postoperative Tegner score was 5.94 (95% CI: 5.41-6.46), indicating a high return to recreational sports. The mean change in Tegner score was 2.48 (p = 0.0604), which was not statistically significant, while Lysholm score improvement was significant at 31.16 points (p = 0.0093). The pooled failure rate across studies was 14% (95% CI: 0-42%). Patients with isolated bucket-handle meniscal tears undergoing surgical repair demonstrate a high rate of return to recreational sports, with significant improvements in Lysholm scores. However, failure rates and study quality variability suggest further high-quality research to make safer conclusions.