Findings: Sagittal proton density MR images of the patient's knee demonstrate truncated anterior and posterior horns of the medial meniscus without the normal bow-tie configuration as well as a low-signal intensity band parallel and anterior to the PCL (double-PCL sign). Coronal STIR images demonstrate a displaced meniscal fragment within the intercondylar notch.

Diagnosis: Bucket-handle tear of the medial meniscus.

Discussion: A displaced longitudinal tear of the meniscus is called a bucket-handle tear because the separated central fragment resembles the handle of a bucket. Patients with bucket-handle tears may present with a locked knee or a lack of full extension. Bucket-handle tears involve the medial meniscus three times more often than the lateral meniscus. The central fragment may be partially displaced or may be completely displaced into the intercondylar notch as is frequently demonstrated on coronal images. Bucket-handle tears effectively reduce the width of the meniscus, resulting in truncation of the anterior and posterior horns on sagittal images, and peripheral sagittal images fail to demonstrate the normal bow-tie configuration of the body of the meniscus. Another helpful imaging finding which is sometimes seen is the double-PCL sign which is the presence of a low-signal intensity band parallel and anterior to the PCL, caused by the displaced meniscal fragment within the intercondylar notch. A partial menisectomy can be performed for nonseparated symptomatic tears.

Reference:
Stoller DW, Cannon WD, Anderson LJ. The Knee. In: Magnetic Resonance Imaging
in Orthopedics and Sports Medicine, 2nd Edition. Stoller DW. Lippincott-Raven;
Eds. 1997:273-277.

Resnick D. Internal Derangements of Joints. In: Diagnosis of Bone and Joint Disorders,
3rd Edition. Ed. Resnick D. W. B. Saunders, Co., Philadelphia; 1995(5):3069-3098.

Weissleder R, Rieumont MJ, Wittenberg J. Primer of Diagnostic Imaging, 2nd Edition.
Mosby, St. Louis; 1997:372-374.

Return to Musculoskeletal Teaching File Page