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Pop Goes the Knee
A 25 year old male presents with right knee pain after a bicycle accident in which his knee twisted after planting his foot while falling off the bicycle. He also reports his knee occasionally "locks" when trying to ambulate since the injury. ROM is restricted with knee extension and flexion.
Pop Goes the Knee
Author: Tyler Jackson, MD
Peer-reviewer: Terese Whipple, MD
Final editor: Alex Tomesch, MD
A 25 year old male presents with right knee pain after a bicycle accident in which his knee twisted after planting his foot while falling off the bicycle. He also reports his knee occasionally "locks" when trying to ambulate since the injury. ROM is restricted with knee extension and flexion.
Radiographic findings?
Images 3 and 4. MRI R Knee (Sagittal PD) Cases
courtesy of Dr. Ahmed Abdrabou, Radiopaedia.org, rID: 25091
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'Double PCL sign' (Image 3) appears on sagittal MRI images of the knee when a bucket handle tear of a meniscus (most commonly the medial meniscus) flips into the intercondylar recess and comes to lie anteroinferior to the PCL mimicking a second smaller PCL [3].
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'Double delta sign' and 'ghost meniscus sign' (Image 4) is resultant of complete peripheral vertical longitudinal tear of the posterior horn and body of the lateral meniscus has allowed the posterior horn to flip into the intercondylar notch and the body to flip directly posterior to a truncated anterior horn [3].
References
[1] Chambers HG, Chambers RC: The natural history of meniscus tears . J Pediatr Orthop. 2019, 39:53-5.
[2] Jarraya M, Roemer FW, Englund M, et al.: Meniscus morphology: does tear type matter? A narrative review with focus on relevance for osteoarthritis research. Semin Arthritis Rheum. 2017, 46:552-61.
[3] Esparragoza-Montero R, Rodriguez-Diaz J, Lanier- Dominguez J, et al. Evaluation of meniscal morphology and relation between the diagnostic findings of magnetic resonance imaging and arthroscopy in lesions of the knee. Invest Clin 2009;50(1): 35-44.
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