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Double PCL sign

Dr Praveen Jha and Dr Frank Gaillard et al.

The double PCL sign appears on sagittal MRI images of the knee when a bucket-handle tear of a meniscus (medial meniscus in 80% of cases) flips medially so that comes to lie anteroinferior to the posterior cruciate ligament (PCL) mimicking a second smaller PCL ^1,2.

A double PCL sign from a torn medial meniscus can essentially only seen in patients who have an intact anterior cruciate ligament (ACL) as this is required to prevent the flipped fragment from migrating further laterally, or not aligning parallel to the PCL ¹.

In a minority of patients, a lateral meniscus bucket handle tear, in the presence of torn ACL, may also give rise to a double PCL sign.

Identifying a double PCL sign is highly specific (98 - 100%) but of variable sensitivity (27 - 53%) for the detection of displaced bucket handle tears ¹.

Associated signs include

Differential diagnosis

accessory meniscofemoral ligament (ligament of Humphry)
- smaller
- closely approximated to the PCL
- normal medial meniscus
medial oblique meniscomeniscal ligament
- normal medial meniscus

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