Goutham Gowdara

This case series evaluated the outcomes of arthroscopic repair in five patients aged over 40 years with chronic medial bucket-handle meniscal tears, with a mean symptom duration of nine months. All patients demonstrated intraoperative adhesions (60% classified as major) along with grade 1 to 2 chondral changes. Despite attempted repair, a 100% failure rate was observed within 2 to 5 months, necessitating subsequent meniscectomy in all cases. Functional outcomes, as measured by the IKDC score, showed only modest improvement following repair (38.2%-54.0%), but improved substantially after meniscectomy (77.5% at one year; mean gain of 39.5%). Similarly, pain scores (VAS) demonstrated significant reduction only after meniscectomy (6.6-2.4). These findings suggest that in middle-aged patients with delayed presentation of chronic bucket-handle tears, the likelihood of repair failure is high, and primary or early meniscectomy may represent a more pragmatic treatment strategy.

Pigmented villonodular synovitis (PVNS) is a rare, benign, and locally aggressive synovial disorder that most commonly affects the knee. The diffuse form carries a high recurrence risk and is challenging to treat, particularly when the posterior compartments are involved. A 29-year-old man presented with recurrent right knee stiffness and swelling without pain, five years after his second arthroscopic synovectomy for diffuse PVNS. MRI revealed extensive synovial proliferation involving the suprapatellar pouch and posterior knee compartment along the posterior cruciate ligament (PCL). He underwent arthroscopic synovectomy using a posterior trans-septal portal for complete posterior access, followed by radiosynoviorthesis with phosphorus-32, structured physiotherapy and adjuvant platelet-rich plasma (PRP) injection. At five-year follow-up, MRI showed moderate residual synovial thickening; however, the clinical outcomes improved markedly. The IKDC score increased from 41.4% to 83.9% and the Tegner-Lysholm score increased from 44% to 94%. The patient regained pain-free ambulation and knee motion from 0° to 120°, with no recurrent swelling. Recurrent diffuse PVNS with posterior compartment involvement benefits from a multimodal approach that integrates advanced arthroscopic techniques and adjuvant therapies. Significant functional recovery is achievable despite residual radiologic changes, highlighting the value of comprehensive management and long-term follow-up.