Magnetic resonance imaging of meniscal bucket-handle tears

Purpose: To define MR signs of meniscal bucket-handle tears and evaluate the diagnostic efficiency of this technique. Materials and methods: Retrospective study of 30 patients with a meniscal bucket-handle tear and 30 with a different type of tear, all proven by arthroscopy. The following MR signs of a bucket-handle tear were evaluated : << separate meniscal fragment >>, << double posterior cruciate ligament >>, << snake sign >> and << double anterior horn >>. Results: A correct diagnosis of a bucket-handle tear was only made in 18/30 of patients. Several of the MR signs were seen in the same patient in 17 cases. A double posterior cruciate ligament was present only in cases of medial meniscus tears. The 12 menisci without these signs, and therefore not diagnosed as bucket-handle tears, were all classified as meniscal tears on the basis of signal extending to the meniscal surface. Nine of these were not displaced into the intercondylar notch at arthroscopy. The interobserver agreement was excellent : kappa = 0.88. Conclusion: The diagnosis of a bucket-handle meniscal tear, if it is displaced, can be made when one or more of the four MR evaluated signs are present. Other forms of meniscal tears are only exceptionally diagnosed as bucket-handle tears.