Double anterior cruciate ligament sign

Last revised by Dr Joachim Feger on 15 Nov 2021

The double anterior cruciate ligament (ACL) sign describes a curvilinear, low signal intensity bandlike structure paralleling the anterior cruciate ligament 1-3 and is of rare occurrence 1.  

It can be seen in bucket-handle meniscal tears from either the medial or lateral meniscus 1-3. Depending on which one of the menisci is involved, the displaced meniscal fragment is entrapped either anterior or posterior to the anterior cruciate ligament.

Correspondingly, the meniscal fragment may be seen in an anterior and superior position to the anterior cruciate ligament in case of a bucket handle tear of the medial meniscus 3 and a posterior and inferior position in case of a bucket handle tear of the lateral meniscus 1,2.

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