Anterior cruciate ligament rupture with medial meniscus bucket handle tear - double PCL sign

Case contributed by Dr Amro Omar


Knee swelling, pain and locking following knee trauma

Patient Data

Age: 40 years
Gender: Male

Images show:

  • anterior cruciate ligament (ACL) rupture
  • bucket handle tear of medial meniscus with double PCL sign
  • parameniscal cyst originating from posterior horn medial meniscus near root attachment
  • bone bruise in the posterolateral corner of the tibia
  • joint effusion

Case Discussion

Typical features of a bucket handle meniscal tear include:

  • commoner at medial versus lateral meniscus
  • truncation and small size of body of meniscus on coronal images
  • "Double PCL sign" on sagittal view

In a suspected case of ACL rupture, the radiologist must:

  • evaluate integrity of the ACL on sagittal, coronal, and axial images
  • look for associated injuries to posterolateral corner structures, medial collateral ligament, or menisci
  • closely inspect the posterior horn lateral meniscus, including the attachment site of meniscofemoral ligament for subtle evidence of tearing
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Case information

rID: 34428
Published: 19th Feb 2015
Last edited: 4th Jul 2020
Inclusion in quiz mode: Included

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