Double PCL sign
Painful weightbearing after a fall.
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Loss of cartilage at medial tibiofemoral joint is seen with small area of subchondral marrow edema at para-articular medial condyles with a degenerative subchondral cyst at posterorlateral tibia. MCL shows mild edema suggesting sprain injury.
The medial meniscus reveals intrasubstance intermediate signal with outward extrusion. The body of the medial meniscus is discontinuous and diminutive posteriorly with excess meniscal tissue at the intercondylar fossa parallel to the sagittal plane simulating the double PCL sign, consistent with a bucket handle tear.
The anterior cruciate ligament shows abnormal configuration appears completely flattened, which is compatible with a full thickness ACL tear.
MRI of the left knee demonstrates a full thickness bucket handle tear of medial meniscus with a complete ACL tear, subchondral marrow edema, MCL strain and osteoarthritic changes at the tibiofemoral articulation.