Anterior cruciate ligament tear/ bucket handle tear of the posterior horn medial meniscus

Case contributed by Dr Heba Mohamed

Presentation

knee twist during playing football

Patient Data

Age: 28 years
Gender: Male

Abnormal discontinuity of the femoral attachment of the anterior cruciate ligament (ACL)  in keeping with torn ACL. Abnormal small size and fragmentation of the posterior horn medial meniscus with double PCL sign on coronal T2, imaging characteristic of bucket handle tear. 

Case Discussion

   The primary signs of Complete anterior cruciate ligament tear include abnormal interruption, orientation or non-recognition of the ligament. The most important of the secondary signs is the bone contusion, many other secondary signs may include anterior translation of the tibia, meniscal injury as well as a joint effusion. The horrible triad of the knee includes torn anterior cruciate, medial collaterals ligaments together with torn posterior horn medial meniscus.

Both horns are triangular in shape and characterized by very well defined outlines.
The posterior horn is always bigger than the anterior horn.  If the meniscus demonstrates abnormal shape, that may be interpreted as a meniscal tear or you should ask about the history of partial meniscectomy.

Bucket handle tear is a displaced horizontal tear. On coronal images, if there are more than two structures in the intercondylar notch: the anterior and posterior cruciate ligament, that will be a displaced meniscal fragment.

 

 

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Case information

rID: 52015
Case created: 18th Mar 2017
Last edited: 23rd Mar 2017
Inclusion in quiz mode: Included

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