Double PCL sign

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

A double PCL sign from a torn medial meniscus can essentially only be 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

Knee pathology

The knee is a complex synovial joint that can be affected by a range of pathologies:

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Article information

rID: 1234
Section: Signs
Tag: knee
Synonyms or Alternate Spellings:
  • Double PCL sign due to a Bucket-handle tear

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Cases and figures

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    Double PCL
    Figure 1: double PCL
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    Case 1
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    Case 2: annotated
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    2 Pcl02
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    Bucket handle tear
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