The double ACL sign: An aberrant bucket-handle tear of lateral meniscus

Alahaidib, Adel; Alrabai, Hamza M.; Alajlan, Ahmed; Al-shehab, Yasser; Al-Ahaideb, Abdulaziz

doi:10.1016/j.amsu.2020.04.006

Cited by 6 publications

(6 citation statements)

References 26 publications

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“…Meniscal injuries are one of the most common musculoskeletal injuries of the knee affecting patients of different populations, genders, ages, and activity. These injuries can be acute or chronic, usual present with pain and mechanical symptoms depending on the severity of the injury and whether it is displaced and trapped in the knee or not [7] , [8] . Among the different types of meniscal tears, a longitudinal tear with displacement of the inner fragment into the intercondylar notch is termed a bucket-handle tear [9] .…”

Section: Discussionmentioning

confidence: 99%

The treatment of bucket handle meniscus tear using “the pulling suture technique”: A new surgical technique

Alsowaigh¹,

Albishi²,

Alfridy³

et al. 2023

International Journal of Surgery Case Reports

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Section: Discussionmentioning

confidence: 99%

The treatment of bucket handle meniscus tear using “the pulling suture technique”: A new surgical technique

Alsowaigh¹,

Albishi²,

Alfridy³

et al. 2023

International Journal of Surgery Case Reports

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“…In literature, MRI signs are described such as a double ACL sign occurring secondarily to BHT of the lateral meniscus with the torn fragment trapped behind the ACL giving the appearance of the double ACL sign (11). This sign otherwise typically occurs due to BHT of the medial meniscus.…”

Section: Discussionmentioning

confidence: 99%

A rare double-delta sign in a bucket handle tear of lateral meniscus: a case report

Zeb¹,

Zeb

Sibtain

2022

J Pak Med Assoc

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The two most common causes of a meniscus tear are trauma and degenerative processes. Meniscus tears clinically present with pain, swelling and limited mobility of the knee joint. Bucket handle tear (BHT) is a full-thickness tear of the meniscus usually involving the inner portion of the medial meniscus. It is three times more likely to occur in the medial meniscus than in the lateral meniscus. Various signs such as the double anterior cruciate ligament (ACL) sign, double posterior cruciate ligament (PCL) sign, and triple PCL sign have helped radiologists diagnose this tear on magnetic resonance imaging (MRI). This case report is about a BHT of the less commonly involved lateral meniscus identified with a double-delta sign on MRI which has rarely been reported. A comparison of various radiological signs reported in the literature has been made, which will aid radiologists in diagnosis and have importance for the medical literature.

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“…The V sign presents a similar appearance to the letter "V," arising from the displacement of the bucket handle tear and the angle of the intact meniscus in axial images [ 5 ]. The double ACL sign manifests as an appearance formed by the compression of the displaced meniscal portion anteriorly or posteriorly to the ACL in lateral meniscus bucket handle tears [ 20 , 21 ].…”

Section: Methodsmentioning

confidence: 99%

“…Most of these signs are well known and extensively discussed in the literature. However, to our knowledge, no study has been published evaluating all of these MR imaging signs of meniscal bucket-handle tears, including the recently identified V-sign [ 5 ] and double ACL sign [ 20 , 21 ] (Figure 8 ,9), in a larger population. This study aims to assess both the recently proposed and well-established MR imaging signs of meniscal bucket-handle tears and to explore any relationships between arthroscopy and MRI findings.…”

Section: Introductionmentioning

confidence: 99%

MRI in the Diagnosis of Bucket Handle Tears: What Is the Current Situation?

Pakdemirli¹,

Cesur²,

Bozkurt³

2023

Cureus

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Introduction The purpose of this study was to determine the utility of current magnetic resonance imaging (MRI) in the diagnosis of bucket-handle meniscal tears. Materials and methods Patients treated for arthroscopic meniscal tears between March 2019 and March 2022 were reviewed. The current study included all patients with bucket handle tears diagnosed arthroscopically and having MRI scans (n=51). A control group of 58 individuals with similar demographic characteristics and meniscal tears apart from bucket handle tears was also formed. The assessment of bucket handle and non-bucket handle tears was performed blindly by a musculoskeletal (MSK) radiologist with 20 years of experience and a trainee radiologist, achieving consensus on group allocation. The MRIs were examined for various findings, including the presence of a bucket handle tear, tear location, presence of anterior cruciate ligament (ACL) rupture, intercondyler notch sign, double anterior horn sign, flipped meniscus sign, double posterior cruciate ligament (PCL) sign, absent bow sign, and the disproportionate posterior horn sign. These well-known signs, detailed in the literature, were evaluated. Additionally, less studied and less commonly known signs such as the V sign and double anterior cruciate ligament sign were assessed. The V sign appears similarly to the letter V, resulting from the displacement of the bucket handle tear and the angle of the intact meniscus on axial images. The double anterior cruciate ligament sign is the appearance formed by the compression of the displaced meniscal part behind the anterior cruciate ligament in bucket handle tears. Results Following the retrospective evaluation of MRI scans, 44 out of 51 tears diagnosed as bucket handle tears by arthroscopy were accurately identified (sensitivity: 86.27%). The same conclusion was reached for MRI scans in 52 out of 58 tears where arthroscopy did not detect a bucket handle tear (specificity: 89.66%). The most prevalent MRI signs in patients with bucket handle tears identified by arthroscopy in the study were the intercondylar notch sign (84.31%), V sign (72.55%), double PCL sign (56.86%), double anterior horn sign (49.02%), absent bow sign (43.14%), flipped meniscus sign (19.61%), disproportionate posterior horn sign (9.80%), and double ACL sign (5.88%). The intercondylar notch sign, V sign, and double PCL sign exhibited the highest sensitivity, while flipped meniscus, disproportionate posterior horn, and double ACL sign demonstrated the highest specificity. Conclusion MRI demonstrates a high level of sensitivity and specificity in identifying meniscal bucket handle tears, particularly when considering the eight MRI signs investigated in this study.

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The double ACL sign: An aberrant bucket-handle tear of lateral meniscus

Cited by 6 publications

References 26 publications

The treatment of bucket handle meniscus tear using “the pulling suture technique”: A new surgical technique

The treatment of bucket handle meniscus tear using “the pulling suture technique”: A new surgical technique

A rare double-delta sign in a bucket handle tear of lateral meniscus: a case report

MRI in the Diagnosis of Bucket Handle Tears: What Is the Current Situation?

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