Answer for BIR CoW 22 Feb 2026
Bucket Handle tear
Findings
Intrasubstance PDFS hyperintensity noted in the anterior cruciate ligament with preserved fibre continuation. Longitudinal vertical tear with central displacement in the inner medial meniscal fragment into the intercondylar notch. The displaced fragment appears as low signal intensity band paralleling the posterior cruciate ligament. - Complex displaced bucket handle tear of medial meniscus. - Intrasubstance tear of anterior cruciate ligament
Discussion
Bucket-handle meniscal tears are a type of displaced vertical meniscal tear where the inner part is displaced centrally. They more commonly occur in the medial meniscus and are often associated with anterior cruciate ligament (ACL) tears. Complex meniscal tears extend in more than one plane, and can in turn create separate flaps of meniscus. Bucket-handle tears can manifest as sensitive but not specific signs: Signs on sagittal view Absent bow tie sign - loss of the normal appearance of the menisci on parasagittal MRI images Double PCL sign - Medial meniscus flips towards the centre of the joint so that it comes to lie anteroinferior to the posterior cruciate ligament (PCL) mimicking a second smaller ligament. Double ACL sign (bucket-hand tears of the lateral meniscus) describes a curvilinear, low signal intensity bandlike structure parallelling the anterior cruciate ligament and is of rare occurrence Double anterior horn / flipped meniscus - on sagittal view Double delta sign - bucket handle meniscal tear when the inner meniscal fragment flipped anteriorly adjacent to the anterior horn of the donor site and is referred to as a displaced bucket handle tear Disproportionately small posterior horn
References:
Nguyen JC, De Smet AA, Graf BK, Rosas HG. MR imaging-based diagnosis and classification of meniscal tears. (2014) Radiographics : a review publication of the Radiological Society of North America, Inc. 34 (4): 981-99. doi:10.1148/rg.344125202 - Pubmed 2. De Smet AA. How I diagnose meniscal tears on knee MRI. (2012) AJR. American journal of roentgenology. 199 (3): 481-99. doi:10.2214/AJR.12.8663 - Pubmed Meniscal fragment in the intercondylar notch on coronal images Truncation and small size of the body of the meniscus on coronal images.
Findings
Intrasubstance PDFS hyperintensity noted in the anterior cruciate ligament with preserved fibre continuation. Longitudinal vertical tear with central displacement in the inner medial meniscal fragment into the intercondylar notch. The displaced fragment appears as low signal intensity band paralleling the posterior cruciate ligament. - Complex displaced bucket handle tear of medial meniscus. - Intrasubstance tear of anterior cruciate ligament
Discussion
Bucket-handle meniscal tears are a type of displaced vertical meniscal tear where the inner part is displaced centrally. They more commonly occur in the medial meniscus and are often associated with anterior cruciate ligament (ACL) tears. Complex meniscal tears extend in more than one plane, and can in turn create separate flaps of meniscus. Bucket-handle tears can manifest as sensitive but not specific signs: Signs on sagittal view Absent bow tie sign - loss of the normal appearance of the menisci on parasagittal MRI images Double PCL sign - Medial meniscus flips towards the centre of the joint so that it comes to lie anteroinferior to the posterior cruciate ligament (PCL) mimicking a second smaller ligament. Double ACL sign (bucket-hand tears of the lateral meniscus) describes a curvilinear, low signal intensity bandlike structure parallelling the anterior cruciate ligament and is of rare occurrence Double anterior horn / flipped meniscus - on sagittal view Double delta sign - bucket handle meniscal tear when the inner meniscal fragment flipped anteriorly adjacent to the anterior horn of the donor site and is referred to as a displaced bucket handle tear Disproportionately small posterior horn
References:
Nguyen JC, De Smet AA, Graf BK, Rosas HG. MR imaging-based diagnosis and classification of meniscal tears. (2014) Radiographics : a review publication of the Radiological Society of North America, Inc. 34 (4): 981-99. doi:10.1148/rg.344125202 - Pubmed 2. De Smet AA. How I diagnose meniscal tears on knee MRI. (2012) AJR. American journal of roentgenology. 199 (3): 481-99. doi:10.2214/AJR.12.8663 - Pubmed Meniscal fragment in the intercondylar notch on coronal images Truncation and small size of the body of the meniscus on coronal images.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!