The Double Posterior Cruciate Ligament (PCL) Sign - Bucket handle tear of medial meniscus.

25 year old young male soccer player presented with a 1 week history of his right knee locking and was not allowed to extend completely as he walked. On physical examination, the left knee appeared minimally swollen but did not feel warm. There was an audible click when the flexed left knee was extended while varus pressure was applied (McMurray test). MRI was performed, Sagittal fat saturated T2 weighted image of the right knee through the intercondylar notch reveals a thin linier fragment of torn meniscus which appears as a low-signal intensity longitudinally oriented band (arrow) lying beneath and parallel to the posterior cruciate ligament (arrow head), creating a double cruciate configuration, referred to as the double posterior cruciate ligament (PCL) sign. The abnormal hyperintensity in keen joint space and supra patellar region is joint effusion. Patient underwent arthroscopic repair of the torn ligament.

The double PCL sign is associated with bucket handle tears of medial meniscus, At MRI this sign relates to the peripheral (bucket) portion of the meniscus and the displaced inner fragment (handle) portion. Identifying the bucket-handle tears early is critical because, depending on how peripheral and complex the tear is, any delay can compromise the chances for repair. If the tear is not reduced, the meniscal fragment risks further maceration.