Background: Bucket handle meniscal tears (BHMT) are complex injuries, accounting for 10%–26% of all meniscal tears. They are often associated with mechanical knee locking and concomitant injuries, most commonly anterior cruciate ligament (ACL) tears. While meniscectomy provides short-term relief, it is linked to early osteoarthritis. Meniscal preservation through repair remains technically challenging but essential for restoring function.

Aim: To evaluate patient-reported outcome measures (PROMs) following BHMT repair and to determine the influence of associated injuries and repair techniques on functional outcomes.

Methods: A retrospective study was conducted at Sri Lakshmi Narayana Institute of Medical Sciences from October 2021 to June 2024. Patients with arthroscopically confirmed BHMT undergoing repair were included, while irreparable tears, advanced osteoarthritis, and prior meniscal surgery were excluded. Preoperative demographics, tear characteristics, and associated injuries were recorded. Repair techniques (all-inside, inside-out, outside-in) were documented. Outcomes were assessed using the Lysholm score, IKDC score, and categorical PROM grading. Statistical comparisons between pre- and postoperative scores were performed using paired t-tests, with subgroup analysis for associated injuries and techniques.

Results: A total of 42 patients (mean age 28 years; 39 males, 3 females) were analyzed, with mean follow-up of 2 years. Medial meniscus involvement predominated (83.3%). Associated injuries included ACL tears (64.3%), patellar OCD (16.7%), PCL avulsion (2.4%), MLKI (2.4%), and MFC osteoarthritis (14.3%). Both Lysholm and IKDC scores improved significantly from preoperative to postoperative assessments (p < 0.001). Combined BHMT repair with ACL reconstruction showed significantly superior PROMs compared with isolated BHMT repair (Lysholm score: 92.4 ± 3.1 vs. 82.1 ± 5.8, p < 0.01; IKDC score: 86.2 ± 4.5 vs. 75.3 ± 8.1, p < 0.01).

Conclusion: Repair of BHMT is a safe and effective procedure that provides significant functional improvement and high patient satisfaction. Concomitant ACL reconstruction enhances outcomes, highlighting the importance of addressing associated injuries during surgery. Meniscal repair techniques (all-inside, inside-out, outside-in) yielded comparable PROMs, supporting meniscal preservation as the preferred strategy.