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Hemi-bucket-handle tears of the meniscus: appearance on MRI and potential surgical implications
Bjorn I Engstrom1, Emily N Vinson, Dean C Taylor
1Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA. bjorn.engstrom@duke.edu
Objectives:
To describe a type of meniscus flap tear resembling a bucket-handle tear, named a "hemi-bucket-handle" tear; to compare its imaging features with those of a typical bucket-handle tear; and to discuss the potential therapeutic implications of distinguishing these two types of tears.
Materials And Methods:
Five knee MR examinations were encountered with a type of meniscus tear consisting of a flap of tissue from the undersurface of the meniscus displaced toward the intercondylar notch. A retrospective analysis of 100 MR examinations prospectively interpreted as having bucket-handle type tears yielded 10 additional cases with this type of tear. Cases of hemi-bucket-handle tears were reviewed for tear location and orientation, appearance of the superior articular surface of the meniscus, presence and location of displaced meniscal tissue, and presence of several classic signs of bucket-handle tears.
Results:
A total of 15/15 tears involved the medial meniscus, had tissue displaced toward the notch, and were mainly horizontal in orientation. The superior surface was intact in 11/15 (73.3%). In 1/15 (6.7%) there was an absent-bow-tie sign; 6/15 (40%) had a double-PCL sign; 14/15 (93.3%) had a double-anterior horn sign.
Conclusion:
We describe a type of undersurface flap tear, named a hemi-bucket-handle tear, which resembles a bucket-handle tear. Surgeons at our institution feel this tear would likely not heal if repaired given its predominantly horizontal orientation, and additionally speculate the tear could be overlooked at arthroscopy. Thus, we feel it is important to distinguish this type of tear from the typical bucket-handle tear.
Insights
A new meniscus tear, the "hemi-bucket-handle" tear, is described. This tear resembles a bucket-handle tear but has distinct imaging features and may be overlooked during arthroscopy, impacting treatment decisions.
Area of Science:
- Orthopedic surgery
- Radiology
- Sports medicine
Background:
- Meniscus tears are common knee injuries.
- Bucket-handle tears are a specific type of meniscus tear requiring distinct management.
- Distinguishing between similar meniscus tear patterns is crucial for effective treatment.
Purpose of the Study:
- To introduce and describe the "hemi-bucket-handle" meniscus tear.
- To compare the magnetic resonance imaging (MRI) features of hemi-bucket-handle tears with typical bucket-handle tears.
- To discuss the clinical and therapeutic implications of differentiating these meniscus injuries.
Main Methods:
- Retrospective review of knee MRI examinations.
- Identification of 15 cases of hemi-bucket-handle tears.
- Analysis of tear location, orientation, meniscal tissue displacement, and associated MRI signs.
Main Results:
- All 15 tears involved the medial meniscus and were horizontal in orientation.
- The superior meniscal surface was intact in 73.3% of cases.
- Specific signs like the "double-PCL sign" and "double-anterior horn sign" were present in varying frequencies.
Conclusions:
- The hemi-bucket-handle tear is a distinct undersurface flap tear.
- Its predominantly horizontal orientation suggests poor healing potential with repair.
- Accurate arthroscopic identification is important to avoid missed diagnoses and guide appropriate surgical or non-surgical management.