bucket handle tear

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Post on 26-May-2015



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  • 1. Dr Arun GuptaDirector imagingDepttDr Rakhee Gupta Contact :Dr Nitu NarulaWeb site : www.spiralctmricentre.comDr Ritesh Mahajan Text references for this presentations :Dr R K Gandhi Musculosketetal MRI ( Kaplan, Helms,Dussault,Anderson,Major)MRI in orthopaedics and sports medicine( David W . Stoller)

2. ( BUCKET HANDLE TEAR OF MEDIAL MENISCUS )BUCKETHANDLE TEARUsually traumaticOccurs in youngpatients aftersignificant traumaUsually in medialrarely in lateralmeniscusLongitudinalvertical tear of the Detached fragment resemblesmeniscus withhandle of the bucket andunstable displaced remaininginner fragment intact part of the meniscus resembles a bucket . 3. The posterior horn of the medial Vertical longitudinal tear is themeniscus is normally greater incommonest bucket handle tear ( 10height than anterior horn ..%). Foreshortening of the posterior horn Normal width of the body of themeniscus is 9mm .with no h/o partial menisectomy is Sagittal images from the body of the associated with bucket handlemeniscus shows bow tie appearancemorphology .in at least two consecutive images . The detached fragment form the The bowtie appearance is absent in body of the medial meniscus canthe bucket handle tear ( ABSENTplace itself anterior to anterior hornBOWTIE SIGN ): (very sensitive for of the medial meniscus ( Anteriorassessment of bucket handle tears )flipped meniscus sign ) . The anterior / posterior horn are The detached fragment can place Truncated itself in the intercondylar notch Hypoplastic ( ventral to PCL ) and this position of With or without internal signal change the PCL gives double PCL appearance ( DOUBLE PCL SIGN ) 4. Common tear in young patients Double delta sign : Flipped inner Associated with significant meniscal fragments adjacenttrauma ( posterior ) to the anterior Associated with ACL injury .horn of the donor site. Unstable meniscal fragment Displaced posterior horn or bodylocks into the intercondylarflap tear may mimic a bucketnotch and involves atleast twohandle tear hence true bucketthird of the meniscal handle tear is : when thirdcircumference . structure ( separate from ACL / Diagnosis of a bucket handlePCL) is documented with intear requires identification of intercondylar notch on more thandisplaced meniscal tissue fromsingle cross-sectional image .posterior to relative anterior Types of vertical longitudinal tears :coronal position . Single vertical longitudinal tear Double delta sign and / or Double / triple vertical longitudinaldouble PCL sign are sagittal MR tear . Broken bucket handle tearsfindings of a displaced bucket Displaced bucket handle tear .handle tear . 5. DOUBLE PCL SIGN / DOUBLE DELTA SIGN( BUCKET HANDLE TEAR OF MEDIALMENISCUS )YOUNG MALEPATIENT1.FOOTBALLPLAYER2.RECENT TRAUMA3.PAIN RIGHT KNEE 6. DOUBLE PCL SIGNDOUBLE PCLSIGNThe detachedfragment can placeitself in theintercondylar notch( ventral toPCL ) and thisposition of the PCLgives double PCLappearance( DOUBLE PCLSIGN) 7. DOUBLE DELTA SIGNDOUBLE DELTA SIGNFlipped inner meniscal fragmentadjacent ( posterior )to the anterior horn of the donor site. 8. ABSENT BOWTIE SIGNABSENTBOWTIE SIGNNormal width of the bodyof the meniscus is 9mm .Sagittal images from thebody of the meniscusshows bowtie appearancein at least two consecutiveNORMAL BOWTIEimages . APPEARANCE OFThe bowtie appearance isabsent in the bucketTHE LATERAL MENISCUShandle tear ( ABSENT BOWTIESIGN ) (very sensitiveABSENT BOWTIEfor assessment of APPEARANCE OFbucket handle tears )THE MEDIAL MENISCUS 9. SAGITTAL STIR IMAGE :( ABSENT BOWTIE SIGN) APPRECIATE LOSS OF NORMALBOWTIE APPEARANCE OF THE BODY OFTHE MEDIAL MENISCUS WITH FLUIDINSUINATING IN THE REGION OF BODY OF MEDIAL MENISCUS 10. CORONAL T1W SEQUENCEAPPRECIATE DETACHED FRAGMENT OFTHE MEDIAL MENISCUS DISPLACED TO THE INTERCONDYLAR NOTCH 11. CONSEQUENT CORONAL IMAGES ( PRIMARILY POSTERIOR ONES) DEPICTING THE DISPLACEDMENISCAL FRAGMENT Diagnosis ofa buckethandle tearrequires identificationof displacedmeniscaltissue fromposterior to relativeanterior coronal position . 12. AXIAL IMAGE IN BUCKET HANDLE TEAR.DONOR SITEMEDIALMENISCUS BODYDISPLACEDMENISCALFIBROCARTILAGEIN THEINTERCONDYLARREGION. 13. Look for the donor site of tear . Look for unstable detached meniscal fibro-cartilage fragment. Attempt to define meniscal Rim size ( 5mm or more will needsurgery) . Look for signs of chronicity ( deformed twisted morphology) Double PCL / Double Delta / absent bowtie signs are to belooked for . Truncation / hypoplasia / foreshortening of the horns shouldbe commented upon. Multiple posterior coronal images should display theunstable / displaced meniscal fibrocartilage fragment todefine bucket handle tear morphology and differentiate itfrom other kind of flap tears.


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