Teaching File

Institute of Radiology "P. Cignolini" - University of Palermo, Italy

Bucket-handle tears of knee menisci

Gianvincenzo Sparacia, MD
Antonio Lo Casto, MD
Leone Filosto, MD

December 28, 1995


Introduction

A bucket-handle tear of the meniscus is a vertical longitudinal tear in which the inner fragment is displaced toward the intercondylar notch of the knee with resultant mechanical locking of the knee joint.
This is the classic type of tear secondary to acute trauma in the young athlete and usually occurs in the medial meniscus.
The name derives from the appearance of the tear, in which the inner displaced fragment resembles the handle and the larger portion of the periphery of the meniscus has the bucket appearance.
A precise MR diagnosis requires identification of the centrally displaced fragment because the peripheral non displaced component may have only a subtle truncated or foreshortened appearance that may escape detection.


MR features

In the coronal plane:
  • truncated triangle shape of the peripheral portion of the meniscus;
  • low intensity band between the posterior cruciate ligament (in the case
    of the medial meniscus) and the tibial plateau, corresponding to the central fragment displaced in the intercondylar notch. In the case of the lateral meniscus the fragment is located beneath the anterior cruciate ligament (not showed).
    		•
    On the sagittal plane this band parallels the posterior or anterior cruciate ligament, depending on the interested meniscus, showing a characteristic "second cruciate posterior or anterior ligament" or "third cruciate ligament" fashion. Click on the images for captions




    References

    1. Filosto L, Lo Casto A, Sparacia G, Grisanti M, Iovane A, Cardinale AE: Bucket-handle tears of knee menisci. Magnetic Resonance findings. Radiol Med 88: 8-12, 1994.

    2. Mink JH, Reicher MA, Crues III JV, Deutsch AL: Magnetic resonance imaging of the knee. Raven Press, New York, 1993.

    3. Singson RD, Fieldman F, Staron R, Kiernan H: MR imaging of displaced bucket-handle tear of the medial meniscus. AJR 156: 121-124, 1991.

    4. Weiss KL, Morehouse HT, Martin Levy I: Sagittal MR images of the knee: a low-signal band parallel to the posterior cruciate ligament caused by a displaced bucket-handle tear. AJR 156: 117-119, 1991.


    Gianvincenzo Sparacia M.D. (radpa@mbox.unipa.it)
    University of Palermo, Institute of Radiology "P. Cignolini"

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