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Fragment-in-notch sign

Dr Frank Gaillard et al.

The fragment-in-notch sign is closely related to, can be thought of as a failed, double PCL sign, in so far as it represents a meniscal fragment lying in the intercondylar notch, but not paralleling the posterior cruciate ligament (PCL).

Although both signs are most frequently seen in the setting of a bucket handle tear, in contrast to double PCL signs is usually due to a medial meniscal tear, the fragment-in-notch sign is more commonly seen with lateral meniscal bucket handle tears ¹. This no doubt is largely due to the anterior cruciate which aids medial fragments aligning with the PCL whereas it impedes lateral fragments from doing so ¹.

The sign may also bee seen with flipped tears and free fragments.