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Other Displaced Meniscus Tears
Donna G. Blankenbaker, MD, FACR; Kirkland W. Davis, MD, FACR; Andrew Sonin, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Synonyms

            • Vertical flap ("parrot beak") tear, flipped meniscus, complex displaced tear
          • Definitions

            • Tear of meniscus in which 1 or more meniscus fragments are displaced from their normal location
            • Bucket-handle and horizontal flap tears discussed in separate chapters
            • "Parrot beak" term not used by most surgeons, not employed in ISAKOS surgical classification system

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    CLINICAL ISSUES

                    • Presentation

                      • Natural History & Prognosis

                        • Treatment

                          DIAGNOSTIC CHECKLIST

                          • Consider

                            • Image Interpretation Pearls

                              Selected References

                              1. Hoover KB et al: Reliability of meniscus tear description: a study using MRI from the Osteoarthritis Initiative. Rheumatol Int. 40(4):635-41, 2020
                              2. KarakoƧ Y et al: The role of magnetic resonance imaging and clinical assessments in predicting meniscal tear surgery. Eklem Hastalik Cerrahisi. 30(2):85-90, 2019
                              3. Shakoor D et al: Diagnosis of knee meniscal injuries by using three-dimensional MRI: a systematic review and meta-analysis of diagnostic performance. Radiology. 290(2):435-45, 2019
                              4. Boody BS et al: Displaced medial and lateral bucket handle meniscal tears with intact ACL and PCL. Orthopedics. 38(8):e738-41, 2015
                              5. Lance V et al: MR imaging characteristics and clinical symptoms related to displaced meniscal flap tears. Skeletal Radiol. 44(3):375-84, 2015
                              6. 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
                              7. Nguyen JC et al: MR imaging-based diagnosis and classification of meniscal tears. Radiographics. 34(4):981-99, 2014
                              8. 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
                              9. Dunoski B et al: MRI of displaced meniscal fragments. Pediatr Radiol. 42(1):104-12, 2012
                              10. 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
                              11. 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
                              12. Eskander MS et al: A lateral meniscus tear incarcerated behind the popliteus tendon: a case report. Knee. 17(5):359-61, 2010
                              13. Kakel R et al: The triple PCL sign: bucket handle tears of both medial and lateral menisci in a chronically ACL-deficient knee. Orthopedics. 33(10):772, 2010
                              14. McKnight A et al: Meniscal tears with displaced fragments: common patterns on magnetic resonance imaging. Skeletal Radiol. 39(3):279-83, 2010
                              15. Marx RG et al: Displacement of the posterior horn of the lateral meniscus into posterolateral compartment: an unusual injury pattern. HSS J. 5(1):9-11, 2009
                              16. Venkatanarasimha N et al: Potential pitfalls of a double PCL sign. Skeletal Radiol. 38(8):735-9, 2009
                              17. Moraux A et al: Inferiorly displaced flap tear of the medial meniscus: sonographic diagnosis. J Ultrasound Med. 27(12):1795-8, 2008
                              18. Boxheimer L et al: Characteristics of displaceable and nondisplaceable meniscal tears at kinematic MR imaging of the knee. Radiology. 238(1):221-31, 2006
                              19. Vande Berg BC et al: Meniscal tears with fragments displaced in notch and recesses of knee: MR imaging with arthroscopic comparison. Radiology. 234(3):842-50, 2005
                              20. Chen HC et al: MR imaging of displaced meniscal tears of the knee. Importance of a "disproportional posterior horn sign". Acta Radiol. 42(4):417-21, 2001
                              21. Lecas LK et al: Inferiorly displaced flap tears of the medial meniscus: MR appearance and clinical significance. AJR Am J Roentgenol. 174(1):161-4, 2000
                              22. 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
                              23. Quinn SF et al: Menisci of the knee: radial MR imaging correlated with arthroscopy in 259 patients. Radiology. 185(2):577-80, 1992
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Imaging

                                  • Clinical Issues

                                    • Diagnostic Checklist

                                      TERMINOLOGY

                                      • Synonyms

                                        • Vertical flap ("parrot beak") tear, flipped meniscus, complex displaced tear
                                      • Definitions

                                        • Tear of meniscus in which 1 or more meniscus fragments are displaced from their normal location
                                        • Bucket-handle and horizontal flap tears discussed in separate chapters
                                        • "Parrot beak" term not used by most surgeons, not employed in ISAKOS surgical classification system

                                      IMAGING

                                      • General Features

                                        • CT Findings

                                          • MR Findings

                                            • Imaging Recommendations

                                              DIFFERENTIAL DIAGNOSIS

                                                CLINICAL ISSUES

                                                • Presentation

                                                  • Natural History & Prognosis

                                                    • Treatment

                                                      DIAGNOSTIC CHECKLIST

                                                      • Consider

                                                        • Image Interpretation Pearls

                                                          Selected References

                                                          1. Hoover KB et al: Reliability of meniscus tear description: a study using MRI from the Osteoarthritis Initiative. Rheumatol Int. 40(4):635-41, 2020
                                                          2. KarakoƧ Y et al: The role of magnetic resonance imaging and clinical assessments in predicting meniscal tear surgery. Eklem Hastalik Cerrahisi. 30(2):85-90, 2019
                                                          3. Shakoor D et al: Diagnosis of knee meniscal injuries by using three-dimensional MRI: a systematic review and meta-analysis of diagnostic performance. Radiology. 290(2):435-45, 2019
                                                          4. Boody BS et al: Displaced medial and lateral bucket handle meniscal tears with intact ACL and PCL. Orthopedics. 38(8):e738-41, 2015
                                                          5. Lance V et al: MR imaging characteristics and clinical symptoms related to displaced meniscal flap tears. Skeletal Radiol. 44(3):375-84, 2015
                                                          6. 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
                                                          7. Nguyen JC et al: MR imaging-based diagnosis and classification of meniscal tears. Radiographics. 34(4):981-99, 2014
                                                          8. 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
                                                          9. Dunoski B et al: MRI of displaced meniscal fragments. Pediatr Radiol. 42(1):104-12, 2012
                                                          10. 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
                                                          11. 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
                                                          12. Eskander MS et al: A lateral meniscus tear incarcerated behind the popliteus tendon: a case report. Knee. 17(5):359-61, 2010
                                                          13. Kakel R et al: The triple PCL sign: bucket handle tears of both medial and lateral menisci in a chronically ACL-deficient knee. Orthopedics. 33(10):772, 2010
                                                          14. McKnight A et al: Meniscal tears with displaced fragments: common patterns on magnetic resonance imaging. Skeletal Radiol. 39(3):279-83, 2010
                                                          15. Marx RG et al: Displacement of the posterior horn of the lateral meniscus into posterolateral compartment: an unusual injury pattern. HSS J. 5(1):9-11, 2009
                                                          16. Venkatanarasimha N et al: Potential pitfalls of a double PCL sign. Skeletal Radiol. 38(8):735-9, 2009
                                                          17. Moraux A et al: Inferiorly displaced flap tear of the medial meniscus: sonographic diagnosis. J Ultrasound Med. 27(12):1795-8, 2008
                                                          18. Boxheimer L et al: Characteristics of displaceable and nondisplaceable meniscal tears at kinematic MR imaging of the knee. Radiology. 238(1):221-31, 2006
                                                          19. Vande Berg BC et al: Meniscal tears with fragments displaced in notch and recesses of knee: MR imaging with arthroscopic comparison. Radiology. 234(3):842-50, 2005
                                                          20. Chen HC et al: MR imaging of displaced meniscal tears of the knee. Importance of a "disproportional posterior horn sign". Acta Radiol. 42(4):417-21, 2001
                                                          21. Lecas LK et al: Inferiorly displaced flap tears of the medial meniscus: MR appearance and clinical significance. AJR Am J Roentgenol. 174(1):161-4, 2000
                                                          22. 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
                                                          23. Quinn SF et al: Menisci of the knee: radial MR imaging correlated with arthroscopy in 259 patients. Radiology. 185(2):577-80, 1992