A 25-year-old male athlete presents with lateral knee pain after a twisting injury. MRI of the knee shows a vertical tear extending from the meniscal body to the superior surface, with a displaced fragment lying parallel to the posterior cruciate ligament within the intercondylar notch. What type of meniscal tear is this?

• A Radial tear of the lateral meniscus
• B Horizontal cleavage tear
• C Bucket-handle tear of the medial meniscus ✓
• D Parrot-beak tear

Explanation

A bucket-handle tear is a longitudinal vertical tear of the meniscus (most commonly the medial meniscus) in which the central fragment displaces into the intercondylar notch. On MRI coronal images, the typical appearances include a small or absent meniscal body (the 'absent bow-tie' sign, normally seen on two consecutive 5 mm sagittal slices), and the displaced inner fragment lying parallel and anterior to the PCL in the notch, producing the 'double PCL' sign on sagittal images. Radial tears disrupt the circumferential fibres and appear as a gap or cleft on coronal images. Horizontal tears are parallel to the tibial plateau.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.