Bucket Handle Meniscal Tear on Knee MRI

Fig: Coronal T2 image (with fat suppression) shows a displaced fragment (arrow) of medial meniscus into the intercondylar notch of the knee. Note intact ACL (arrowheads).

What is 'Bucket-Handle' Tear?
- Longitudinal, peripheral tear of the meniscus with displacement of fragment toward the intercondylar notch of the knee
Leads to locked knee and surgery (debridement or repair) is necessary
If occurs at the outer 1/3 (white/white zone), only debridement; if middle and peripheral third (white/red, red/red zones) require repair

How to Diagnose?
- Using MRI with coronal and sagittal planes
- Look for extra-structure in the intercondylar notch on coronal image!
Double PCL (posterior cruciate ligament) on sagittal image
- Donor meniscus (usually medial) look smaller than usual (key to differentiate bucket-handle tear from normal oblique intermeniscal ligament)

Reference:
Stoller DW, et al. Diagnostic imaging: orthopedics. 2004

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