Meniscal Bucket-Handle Tear

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