Absent bow tie sign (knee)
Last revised by Frank Gaillard on 6 Sep 2022
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Citation:
Gaillard F, Elfeky M, Bell D, et al. Absent bow tie sign (knee). Reference article, Radiopaedia.org (Accessed on 06 Oct 2024) https://doi.org/10.53347/rID-7218
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7218
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At the time the article was created Frank Gaillard had no recorded disclosures.
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At the time the article was last revised Frank Gaillard had the following disclosures:
- Radiopaedia Australia Pty Ltd and Radiopaedia Events Pty Ltd, Director, Founder and CEO (Radiopaedia) (ongoing)
- Biogen Australia Pty Ltd, Investigator-Initiated Research Grant for CAD software in multiple sclerosis: finished Oct 2021 (past)
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- Absent bow tie sign in knee
The absent bow tie sign represents the loss of the normal appearance of the menisci on parasagittal MRI images and is suggestive of meniscal injury.
Normally the medial and lateral menisci appear as low signal triangular structures linked by a thin body located between the femoral condyles and tibial plateau. The appearance of the menisci has been likened to a bow tie.
As the normal meniscus laterally measures 9-12 mm in width, it should be seen on a number of adjacent images (2-3 images if imaged with 3 mm thick slices with a 1 mm skip).
An absent bow tie sign is therefore when less than two sagittal slices demonstrate a normal body of the meniscus and is suggestive of meniscal pathology, including:
- bucket handle tear with displacement (often with a double PCL sign)
- flap tear with displacement (i.e. bucket handle, but the handle at one end has come loose)
- free fragment with displacement (i.e. bucket handle, but the handle at both ends has come loose)
Other meniscal changes can, however, appear similar, including:
- prior resection of a meniscal tear
- degenerative maceration of the inner edge of the meniscus
- small patients (children / small adults)
Related pathology
In contrast, if there are more 2 or 3 sagittal images with a visible bow-tie this implies a discoid meniscus; obviously, this depends on the slice thickness and skip width.
References
- 1. The Absent Bow Tie Sign1. (2000) Radiology. 215 (1): 263-5. doi:10.1148/radiology.215.1.r00ap25263 - Pubmed
- 2. C A Helms, A Laorr, W D Cannon, Jr. The absent bow tie sign in bucket-handle tears of the menisci in the knee. (2013) AJR. American journal of roentgenology. 170 (1): 57-61. doi:10.2214/ajr.170.1.9423600 - Pubmed
Incoming Links
Articles:
Cases:
- Bucket-handle meniscal tear
- Medial meniscus bucket handle tear with ACL tear
- Bucket-handle meniscal tear
- Double PCL sign
- Bucket-handle medial meniscal tear
- Lateral meniscus bucket handle tear with ACL tear and double PCL
- Double PCL sign
- Bucket handle tear - medial meniscus
- Pivot shift injury - ACL, medial meniscus and MCL tears
Related articles: Knee pathology
The knee is a complex synovial joint that can be affected by a range of pathologies:
- bone and cartilage
-
knee fractures
- distal femoral condyle fracture
- tibial plateau fracture (classification)
- patella fracture
-
avulsion fractures of the knee
- arcuate complex avulsion fracture (arcuate sign)
- anterior cruciate ligament avulsion fracture
- biceps femoris avulsion fracture
- iliotibial band avulsion fracture
- quadriceps tendon avulsion fracture
- patellar sleeve fracture
- posterior cruciate ligament avulsion fracture
- reverse Segond fracture
- Segond fracture
- semimembranosus tendon avulsion fracture
- Stieda fracture chronic avulsion injuries
- dislocation
- chondromalacia patellae
- osteoarthritis of the knee
- osteochondral
- patterns of bone bruise in knee injury
-
knee fractures
- ligaments
- anterior cruciate ligament tear
- anterior cruciate ligament ganglion cyst
- anterior cruciate ligament mucoid degeneration
- posterior cruciate ligament tear
- medial collateral ligament tear
- lateral collateral ligament tear
- medial patellofemoral ligament tear
- posterolateral corner injury
- posteromedial corner injury
- tendons
- meniscal lesions
- bursosynovial lesions
- fat pad
- popliteal fossa
- fascia
- alignment
- knee
- patellofemoral
- gamut
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