Bucket-handle meniscus tear

Case contributed by Yasser Asiri

Presentation

History of twisting injury 1 week ago.

Patient Data

Age: 20 years
Gender: Male
mri

The posterior horn of the lateral meniscus is not seen in its expected location and is flipped and displaced anteriorly adjacent to the anterior horn which gives the appearance of Double delta sign.  Subchondral high signal intensity in the fluid sensitive sequences is seen in the medial tibial spine denoting subchondral edema likely related to bone contusion. 

The medial meniscus, medial collateral ligament and cruciate ligaments are intact. A small amount of joint effusions seen. The extensor mechanism is unremarkable. Normal muscle bulk and signal intensity. Normal bone marrow signal intensity. 

Case Discussion

The diagnosis of bucket handle tear usually is made when a torn displaced meniscus fragment is identified around the anterior horn or adjacent to the PCL. Pseudohypertrophy of the anterior horn of the lateral meniscus or double delta sign is commonly described in bucket handle tear of the lateral meniscus. It postulated that the ACL will act as a barrier preventing the displaced lateral meniscus fragment to enter the intercondylar region due to the close location between the ACL and the lateral meniscus.  Double PCL sign, on the other hand, is usually seen in case of displaced tear of the medial meniscus.

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