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

Abstract

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.

Keywords: bucket handle tear; meniscal tear; meniscus tear; mri; signs.

Figure 1. The sagittal image showing the bucket handle tear (red arrow) forming the double posterior cruciate ligament sign.

Figure 2. The sagittal image showing the bucket handle tear displaced through the anterior horn forming the flipped meniscus sign (red arrow).

Figure 3. The sagittal image showing the bucket handle tear forming the absent bow tie sign (red arrow).

Figure 4. The sagittal image showing the bucket handle tear forming the disproportional posterior horn sign (red arrow).

Figure 5. The sagittal image showing the bucket handle tear forming the double anterior horn sign (red arrow).

Figure 6. The coronal image showing the bucket handle tear at the intercondylar distance forming the intercondylar notch sign (red arrow).

Figure 7. The axial image showing the bucket handle tear forming the V sign (red arrow).

Figure 8. The sagittal image shows the bucket handle tear forming the double anterior cruciate ligament sign (red arrow).

Figure 9. The axial image showing the bucket handle tear (blue arrow) placed posterior to the anterior cruciate ligament (ACL) (red arrow) forming the double ACL sign in sagittal images.