Anterior cruciate ligament tear and bucket-handle meniscal tear

Case contributed by Dr Mate Kover

Presentation

Pain and locked knee after a soccer injury.

Patient Data

Age: 50 years
Gender: Male

No fracture is seen.  The lateral femoral notch sign suggests anterior cruciate ligament tear ( the depth is 1,9 mm).
A large amount of fluid is in the suprapatellar recess.
Next to the medial femoral condyle, a small calcification is seen

The anterior cruciate ligament lost its continuity, heterogeneous. The posterior cruciate ligament looks normal.
A large amount of fluid and moderate synovial proliferation is in the knee joint.
Double PCL sign suggests a bucket-handle meniscal tear, the fragmented part of the medial meniscus displaced in the intercondylar fossa.
Edema is visible in the posterior tibial condyle due to hyperextension and a cyst-like lesion in the dorsal part of the femoral condyle; either it can be traumatic and degenerative. 

Case Discussion

The patient was injured during soccer. On the x-ray, no fracture was seen, a large amount of fluid in the knee joint and the lateral femoral notch sign suggested anterior cruciate ligament tear. The MRI examination confirmed the complete tear of the anterior cruciate ligament and showed a displaced, bucket-handle medial meniscal tear. The ruptured ACL was repaired surgically, and also medial meniscectomy was done.

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