My MRI says bucket-handle tear. What does that mean?

The shape of the tear

Picture the C-shaped meniscus split along its length, parallel to its curved edge. The outer rim stays in place against the joint capsule. The inner strip, now free in the middle but still joined at the front and back, can swing into the notch in the centre of the knee. That displaced strip is what blocks the knee from straightening.

Terms you may see in the report

• Displaced fragment: the strip has moved out of its normal position
• Double PCL sign: the flipped meniscus lies just in front of the posterior cruciate ligament and looks like a second ligament on side-on images
• Fragment in the notch: the strip is sitting in the central space between the bones
• Absent bow tie: the normal appearance of the meniscus is missing because part of it has moved
• Associated ACL tear: common, especially with medial bucket-handle tears in sport

Why it is treated differently from small tears

Many small or degenerative meniscus tears are managed with physiotherapy. A bucket-handle tear is a large, unstable tear that tends to keep catching or locking, and it involves a big portion of the meniscus. Because losing that much meniscus raises the long-term risk of arthritis, the aim is usually to reduce the strip back into place and repair it with stitches, often in the same operation as an ACL reconstruction if needed.

Next step

Bring your MRI images and report to a knee surgeon soon. At Aman Hospital in Doha, Dr. Gelber will check whether the knee is locked, assess the ACL and discuss timing. Repair is generally more likely to succeed when the tear is recent and the meniscus tissue is in good condition.