Unusual pattern of bucket-handle, medial meniscal tear in magnetic resonance imaging

We present an unusual case of a medial meniscal tear in which a large fragment of meniscus was displaced posteriorly, outside the intercondylar notch, posterior to the posterior cruciate ligament (PCL). The appearance mimicked a second PCL posteriorly. The extensive longitudinal ("bucket-handle") tear was detached from the anterior horn of the meniscus but remained in continuity with the posterior tibial attachment. The fragment was prevented from displacement into the intercondylar notch by its large size, the ligament of Humphrey, and the anatomic location of the PCL. This case highlights the value of thin-section, high-resolution, cartilage-sensitive imaging, not only in defining the extent, location, and source of displaced meniscal fragments but also in demonstrating associated chondral injuries.