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Meniscal Bucket-Handle Tear
Andrew Sonin, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Bucket-handle tear (BHT)
            • Definitions

              • Extensive vertical longitudinal meniscal tear with mesial displacement of free edge fragment toward or into intercondylar notch
              • Displaced fragment maintains anterior and posterior attachments to peripheral remnant
              • Broken BHT: Anterior or posterior attachment of displaced fragment disrupted

            IMAGING

            • General Features

              • MR Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    CLINICAL ISSUES

                    • Presentation

                      • Demographics

                        • Natural History & Prognosis

                          • Treatment

                            DIAGNOSTIC CHECKLIST

                            • Consider

                              • Image Interpretation Pearls

                                • Reporting Tips

                                  Selected References

                                  1. Boody BS et al: Displaced medial and lateral bucket handle meniscal tears with intact ACL and PCL. Orthopedics. 38(8):e738-41, 2015
                                  2. LaPrade CM et al: Meniscal root tears: a classification system based on tear morphology. Am J Sports Med. 43(2):363-9, 2015
                                  3. Liu C et al: Double PCL sign does not always indicate a bucket-handle tear of medial meniscus. Knee Surg Sports Traumatol Arthrosc. ePub, 2015
                                  4. Sebaaly A et al: Bilateral Wrisberg discoid menisci mimicking bucket handle tears associated with osteochondritis dissecans: case report. J Pediatr Orthop B. 24(1):75-8, 2015
                                  5. Ahn JH et al: The double flipped meniscus sign: unusual MRI findings in bucket-handle tear of the lateral meniscus. Knee. 21(1):129-32, 2014
                                  6. Nguyen JC et al: MR imaging-based diagnosis and classification of meniscal tears. Radiographics. 34(4):981-99, 2014
                                  7. Prasad A et al: MRI imaging of displaced meniscal tears: Report of a case highlighting new potential pitfalls of the MRI signs. Indian J Radiol Imaging. 24(3):291-6, 2014
                                  8. Davis KW et al: Magnetic resonance imaging and arthroscopic appearance of the menisci of the knee. Clin Sports Med. 32(3):449-75, 2013
                                  9. Dunoski B et al: MRI of displaced meniscal fragments. Pediatr Radiol. 42(1):104-12, 2012
                                  10. Engstrom BI et al: Hemi-bucket-handle tears of the meniscus: appearance on MRI and potential surgical implications. Skeletal Radiol. 41(8):933-8, 2012
                                  11. Jung JY et al: Meniscal tear configurations: categorization with 3D isotropic turbo spin-echo MRI compared with conventional MRI at 3 T. AJR Am J Roentgenol. 198(2):W173-80, 2012
                                  12. Lim HC et al: Intra-articular patterns of bucket handle meniscal tears and its relation to reducibility. Clin Orthop Surg. 4(2):129-33, 2012
                                  13. Rao N et al: Use of the V-sign in the diagnosis of bucket-handle meniscal tear of the knee. Skeletal Radiol. 41(3):293-7, 2012
                                  14. Takayama K et al: The double ACL sign: an unusual bucket-handle tear of medial meniscus. Knee Surg Sports Traumatol Arthrosc. 19(8):1343-6, 2011
                                  15. Yue BW et al: Wrisberg variant of the discoid lateral meniscus with flipped meniscal fragments simulating bucket-handle tear: MRI and arthroscopic correlation. Skeletal Radiol. 40(8):1089-94, 2011
                                  16. Venkatanarasimha N et al: Potential pitfalls of a double PCL sign. Skeletal Radiol. 38(8):735-9, 2009
                                  17. Yoon JR et al: A novel technique for arthroscopic reduction and repair of a bucket-handle meniscal tear. Knee Surg Sports Traumatol Arthrosc. 17(11):1332-5, 2009
                                  18. Feng H et al: Second-look arthroscopic evaluation of bucket-handle meniscus tear repairs with anterior cruciate ligament reconstruction: 67 consecutive cases. Arthroscopy. 24(12):1358-66, 2008
                                  19. Schlossberg S et al: Bucket handle tears of the medial meniscus: meniscal intrusion rather than meniscal extrusion. Skeletal Radiol. 36(1):29-34, 2007
                                  20. Yoo JH et al: Posterior double PCL sign: a case report of unusual MRI finding of bucket-handle tear of medial meniscus. Knee Surg Sports Traumatol Arthrosc. 15(11):1343-5, 2007
                                  21. Makdissi M et al: MRI-negative bucket-handle tears of the lateral meniscus in athletes: a case series. Knee Surg Sports Traumatol Arthrosc. 14(10):1012-6, 2006
                                  22. Shelbourne KD et al: Digital radiographic evaluation of medial joint space narrowing after partial meniscectomy of bucket-handle medial meniscus tears in anterior cruciate ligament-intact knees. Am J Sports Med. 34(10):1648-55, 2006
                                  23. Ververidis AN et al: Meniscal bucket handle tears: a retrospective study of arthroscopy and the relation to MRI. Knee Surg Sports Traumatol Arthrosc. 14(4):343-9, 2006
                                  24. Shelbourne KD et al: Comparison of partial meniscectomy versus meniscus repair for bucket-handle lateral meniscus tears in anterior cruciate ligament reconstructed knees. Arthroscopy. 20(6):581-5, 2004
                                  25. Aydingöz U et al: MR imaging of meniscal bucket-handle tears: a review of signs and their relation to arthroscopic classification. Eur Radiol. 13(3):618-25, 2003
                                  26. Dorsay TA et al: Bucket-handle meniscal tears of the knee: sensitivity and specificity of MRI signs. Skeletal Radiol. 32(5):266-72, 2003
                                  27. Shelbourne KD et al: Meniscal repair compared with meniscectomy for bucket-handle medial meniscal tears in anterior cruciate ligament-reconstructed knees. Am J Sports Med. 31(5):718-23, 2003
                                  28. McAllister DR et al: Spontaneous healing of a bucket-handle lateral meniscal tear in an anterior cruciate ligament-deficient knee. A case report. Am J Sports Med. 29(5):660-2, 2001
                                  29. Helms CA et al: The absent bow tie sign in bucket-handle tears of the menisci in the knee. AJR Am J Roentgenol. 170(1):57-61, 1998
                                  30. Magee TH et al: MRI of meniscal bucket-handle tears. Skeletal Radiol. 27(9):495-9, 1998
                                  31. Wright DH et al: Bucket-handle tears of the medial and lateral menisci of the knee: value of MR imaging in detecting displaced fragments. AJR Am J Roentgenol. 165(3):621-5, 1995
                                  32. Hede A et al: The long term outcome of open total and partial meniscectomy related to the quantity and site of the meniscus removed. Int Orthop. 16(2):122-5, 1992
                                  33. Singson RD et al: MR imaging of displaced bucket-handle tear of the medial meniscus. AJR Am J Roentgenol. 156(1):121-4, 1991
                                  34. Manco LG et al: Bucket-handle tears of the meniscus: appearance at CT. Radiology. 168(3):709-12, 1988
                                  35. Shakespeare DT et al: The bucket-handle tear of the meniscus. A clinical and arthrographic study. J Bone Joint Surg Br. 65(4):383-7, 1983
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Clinical Issues

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Bucket-handle tear (BHT)
                                            • Definitions

                                              • Extensive vertical longitudinal meniscal tear with mesial displacement of free edge fragment toward or into intercondylar notch
                                              • Displaced fragment maintains anterior and posterior attachments to peripheral remnant
                                              • Broken BHT: Anterior or posterior attachment of displaced fragment disrupted

                                            IMAGING

                                            • General Features

                                              • MR Findings

                                                • Imaging Recommendations

                                                  DIFFERENTIAL DIAGNOSIS

                                                    CLINICAL ISSUES

                                                    • Presentation

                                                      • Demographics

                                                        • Natural History & Prognosis

                                                          • Treatment

                                                            DIAGNOSTIC CHECKLIST

                                                            • Consider

                                                              • Image Interpretation Pearls

                                                                • Reporting Tips

                                                                  Selected References

                                                                  1. Boody BS et al: Displaced medial and lateral bucket handle meniscal tears with intact ACL and PCL. Orthopedics. 38(8):e738-41, 2015
                                                                  2. LaPrade CM et al: Meniscal root tears: a classification system based on tear morphology. Am J Sports Med. 43(2):363-9, 2015
                                                                  3. Liu C et al: Double PCL sign does not always indicate a bucket-handle tear of medial meniscus. Knee Surg Sports Traumatol Arthrosc. ePub, 2015
                                                                  4. Sebaaly A et al: Bilateral Wrisberg discoid menisci mimicking bucket handle tears associated with osteochondritis dissecans: case report. J Pediatr Orthop B. 24(1):75-8, 2015
                                                                  5. Ahn JH et al: The double flipped meniscus sign: unusual MRI findings in bucket-handle tear of the lateral meniscus. Knee. 21(1):129-32, 2014
                                                                  6. Nguyen JC et al: MR imaging-based diagnosis and classification of meniscal tears. Radiographics. 34(4):981-99, 2014
                                                                  7. Prasad A et al: MRI imaging of displaced meniscal tears: Report of a case highlighting new potential pitfalls of the MRI signs. Indian J Radiol Imaging. 24(3):291-6, 2014
                                                                  8. Davis KW et al: Magnetic resonance imaging and arthroscopic appearance of the menisci of the knee. Clin Sports Med. 32(3):449-75, 2013
                                                                  9. Dunoski B et al: MRI of displaced meniscal fragments. Pediatr Radiol. 42(1):104-12, 2012
                                                                  10. Engstrom BI et al: Hemi-bucket-handle tears of the meniscus: appearance on MRI and potential surgical implications. Skeletal Radiol. 41(8):933-8, 2012
                                                                  11. Jung JY et al: Meniscal tear configurations: categorization with 3D isotropic turbo spin-echo MRI compared with conventional MRI at 3 T. AJR Am J Roentgenol. 198(2):W173-80, 2012
                                                                  12. Lim HC et al: Intra-articular patterns of bucket handle meniscal tears and its relation to reducibility. Clin Orthop Surg. 4(2):129-33, 2012
                                                                  13. Rao N et al: Use of the V-sign in the diagnosis of bucket-handle meniscal tear of the knee. Skeletal Radiol. 41(3):293-7, 2012
                                                                  14. Takayama K et al: The double ACL sign: an unusual bucket-handle tear of medial meniscus. Knee Surg Sports Traumatol Arthrosc. 19(8):1343-6, 2011
                                                                  15. Yue BW et al: Wrisberg variant of the discoid lateral meniscus with flipped meniscal fragments simulating bucket-handle tear: MRI and arthroscopic correlation. Skeletal Radiol. 40(8):1089-94, 2011
                                                                  16. Venkatanarasimha N et al: Potential pitfalls of a double PCL sign. Skeletal Radiol. 38(8):735-9, 2009
                                                                  17. Yoon JR et al: A novel technique for arthroscopic reduction and repair of a bucket-handle meniscal tear. Knee Surg Sports Traumatol Arthrosc. 17(11):1332-5, 2009
                                                                  18. Feng H et al: Second-look arthroscopic evaluation of bucket-handle meniscus tear repairs with anterior cruciate ligament reconstruction: 67 consecutive cases. Arthroscopy. 24(12):1358-66, 2008
                                                                  19. Schlossberg S et al: Bucket handle tears of the medial meniscus: meniscal intrusion rather than meniscal extrusion. Skeletal Radiol. 36(1):29-34, 2007
                                                                  20. Yoo JH et al: Posterior double PCL sign: a case report of unusual MRI finding of bucket-handle tear of medial meniscus. Knee Surg Sports Traumatol Arthrosc. 15(11):1343-5, 2007
                                                                  21. Makdissi M et al: MRI-negative bucket-handle tears of the lateral meniscus in athletes: a case series. Knee Surg Sports Traumatol Arthrosc. 14(10):1012-6, 2006
                                                                  22. Shelbourne KD et al: Digital radiographic evaluation of medial joint space narrowing after partial meniscectomy of bucket-handle medial meniscus tears in anterior cruciate ligament-intact knees. Am J Sports Med. 34(10):1648-55, 2006
                                                                  23. Ververidis AN et al: Meniscal bucket handle tears: a retrospective study of arthroscopy and the relation to MRI. Knee Surg Sports Traumatol Arthrosc. 14(4):343-9, 2006
                                                                  24. Shelbourne KD et al: Comparison of partial meniscectomy versus meniscus repair for bucket-handle lateral meniscus tears in anterior cruciate ligament reconstructed knees. Arthroscopy. 20(6):581-5, 2004
                                                                  25. Aydingöz U et al: MR imaging of meniscal bucket-handle tears: a review of signs and their relation to arthroscopic classification. Eur Radiol. 13(3):618-25, 2003
                                                                  26. Dorsay TA et al: Bucket-handle meniscal tears of the knee: sensitivity and specificity of MRI signs. Skeletal Radiol. 32(5):266-72, 2003
                                                                  27. Shelbourne KD et al: Meniscal repair compared with meniscectomy for bucket-handle medial meniscal tears in anterior cruciate ligament-reconstructed knees. Am J Sports Med. 31(5):718-23, 2003
                                                                  28. McAllister DR et al: Spontaneous healing of a bucket-handle lateral meniscal tear in an anterior cruciate ligament-deficient knee. A case report. Am J Sports Med. 29(5):660-2, 2001
                                                                  29. Helms CA et al: The absent bow tie sign in bucket-handle tears of the menisci in the knee. AJR Am J Roentgenol. 170(1):57-61, 1998
                                                                  30. Magee TH et al: MRI of meniscal bucket-handle tears. Skeletal Radiol. 27(9):495-9, 1998
                                                                  31. Wright DH et al: Bucket-handle tears of the medial and lateral menisci of the knee: value of MR imaging in detecting displaced fragments. AJR Am J Roentgenol. 165(3):621-5, 1995
                                                                  32. Hede A et al: The long term outcome of open total and partial meniscectomy related to the quantity and site of the meniscus removed. Int Orthop. 16(2):122-5, 1992
                                                                  33. Singson RD et al: MR imaging of displaced bucket-handle tear of the medial meniscus. AJR Am J Roentgenol. 156(1):121-4, 1991
                                                                  34. Manco LG et al: Bucket-handle tears of the meniscus: appearance at CT. Radiology. 168(3):709-12, 1988
                                                                  35. Shakespeare DT et al: The bucket-handle tear of the meniscus. A clinical and arthrographic study. J Bone Joint Surg Br. 65(4):383-7, 1983