Case 40 - 22 year old male with right knee injury 7 months prior and persistent pain
22 year old male with right knee injury seven months prior and persistent pain.
- On the coronal images look at how truncated and small the body of the medial meniscus appears compared to the contralateral side.
- We also an abnormal hypointense structure within the medial intercondylar notch. On sagittal images this hypointense structure appears like a second PCL, sitting anterior to the actual PCL: this is referred to as a double PCL sign and is highly specific for a bucket handle tear of the medial meniscus.
- The morphology of the tear is well seen on axial images. Again, note the mesially displaced fragment within the intercondylar notch. Also note the fragment's attachments to the meniscus both anteriorly and posteriorly.
- Don't forget to check the other structures! The fibers of the anterior cruciate ligament are completely torn. It's easy to miss given the absence of edema. Given the provided history this is compatible with a chronic ACL tear.
Bucket handle tears are a special subtype of vertical longitudinal meniscal tears, in which the free edge fragment becomes mesially displaced into the intercondylar notch. It's important to ensure that the displaced fragment maintains anterior and posterior attachments to the peripheral remnant. While the "double PCL sign" is not very sensitive for a medial bucket handle tear, it is highly specific. More sensitive signs of a bucket handle tear are truncation of the meniscus seen on coronal and sagittal images with a contiguous fragment within the intercondylar notch.
Accession: CL0055
Study description: MR JOINT LOWER KNEE-RT
Case discussion: