Double posterior cruciate ligament sign

Last revised by Dr Joachim Feger on 15 Nov 2021

The double posterior cruciate ligament (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 center of the joint so that it comes to lie anteroinferior to the posterior cruciate ligament (PCL) mimicking a second smaller ligament.

A double posterior cruciate ligament 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 posterior cruciate ligament 1.

In a minority of patients, a lateral meniscus bucket handle tear, in the presence of torn anterior cruciate ligament, may also give rise to a double posterior cruciate ligament sign.

Identifying a double posterior cruciate ligament 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

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Cases and figures

  • Figure 1: double PCL
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  • Case 1
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  • Case 2: annotated
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  • Case 3
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  • Case 4
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  • Case 5
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  • Case 6
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  • Case 7
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  • Case 8
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  • Case 9
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  • Case 10
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  • Case 11
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  • Case 12
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  • Case 13
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  • Case 14
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  • Case 15
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  • Case 16: in the coronal plane
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