Ananalysis of the Clinical and MRI Findings of the Bucket: Handle Meniscal Tears of the Knee Joint

Lim, Hong Chul; Jo, Jeong Hyeon; Jeon, Seung Joo; Park, Dong

Abstract

Recently MRI has been shown to be a sensitive and specific study for the noninvasive detection of meniscal tears and several MRI findings of bucket-handle meniscal tears have been reported. Therefore, the MRI findings of the menisci proven to be the bucket-handle tear with arthroscopy were evaluated and the typical MRI findings seen to be the bucket-handle meniscal tear of the knee were analysed. 76 patients with proven bucket-handle meniscal tears arthroscopically were reviewed retrospectively, in which MRI was performed in 24 patients. The 3 typical findings of bucket-handle meniscal tears were assessed: double PCL (posterior cruciate ligament) sign, flipped meniscus sign, and fragment in the intercondylar notch. In 245 cases of meniscus tears, bucket-handle meniscal tears were 76 cases (31.0%) with 52 cases at medial meniscus and 24 cases at lateral meniscus. As to clinical and physical findings of the bucket-handle meniscal tears, McMurray test, locking, joint line tenderness and giving way sense were presented in orders. The sites of bucket-handle meniscal tear were medial meniscus in 17 cases and lateral in 7 cases. The double PCL sign was seen in 10 cases (58.8%) of in medial bucket-handle meniscal tears and in 3 cases (42.9%) of 7 lateral bucket-handle meniscal tears. The flipped meniscus sign were seen in 3 cases (17.6%) of medial bucket-handle meniscal tears and in 3 cases (42.9 %) of lateral bucket-handle meniscal tears. Fragments were identified in the intercondylar notch in 8 cases (47.1%) of medial bucket-handle meniscal tears and in 3 cases (42.9%) of lateral bucket-handle meniscal tears. There were 19 cases (79.2%) in which at least one or more typical findings were presented on MR images. The MRI is a sensitive study for detection of bucket-handle meniscal tears but precise interpretation of MRI is needed for diagnosis of bucket-handle tears. In this respect, the above three typical findings are helpful and reproducible for diagnosis of bucket-handle meniscal tears with MR images; double PCL sign, fragment in the intercondylar notch and flipped meniscus sign.