Skip to main content

Bucket-handle meniscal tears of the knee: sensitivity and specificity of MRI signs



To determine the sensitivity and specificity of reported MRI signs in the evaluation of bucket-handle tears of the knee.

Design and patients

A retrospective analysis of 71 knee MR examinations that were read as displaying evidence of a bucket-handle or "bucket-handle type" tear was performed. We evaluated for the presence or absence of the absent bow tie sign, the coronal truncation sign, the double posterior cruciate ligament (PCL) sign, the anterior flipped fragment sign, and a fragment displaced into the intercondylar notch. Sensitivity and specificity were calculated relative to the gold standard of arthroscopy.


Forty-three of 71 cases were surgically proven as bucket-handle tears. The absent bow tie sign demonstrated a sensitivity of 88.4%. The presence of at least one of the displaced fragment signs had a sensitivity of 90.7%. A finding of both the absent bow tie sign and one of the displaced fragment signs demonstrated a specificity of 85.7%. The double PCL sign demonstrated a specificity of 100%. The anterior flipped meniscus sign had a specificity of 89.7%.


Bucket-handle tears of the menisci, reported in about 10% of most large series, have been described by several signs with MRI. This report gives the sensitivity and specificity of MRI for bucket-handle tears using each of these signs independently and in combination. MRI is shown to be very accurate for diagnosing bucket-handle tears when two or more of these signs coexist.

This is a preview of subscription content, access via your institution.

Fig. 1.
Fig. 2.
Fig. 3.
Fig. 4.
Fig. 5.
Fig. 6.
Fig. 7.


  1. De Smet A, Graf B. Meniscal tears missed on MR imaging: relationship to meniscal tear patterns and anterior cruciate ligament tears. AJR Am J Roentgenol 1994; 162:905–911.

    PubMed  Google Scholar 

  2. Crues JI, Mink J, Levy T, Lotysch M, Stoller D. Meniscal tears of the knee: accuracy of MR imaging. Radiology 1987; 164:445–448.

    PubMed  Google Scholar 

  3. Fischer SP, Fox JM, Del Pizzo W, Friedman MJ, Snyder SJ, Ferkel RD. Accuracy of diagnoses from magnetic resonance imaging of the knee: a multicenter analysis of one thousand and fourteen patients. J Bone Joint Surg Am 1991; 73:2–10.

    CAS  PubMed  Google Scholar 

  4. Shakespeare DT, Rigby HS. The bucket-handle tear of the meniscus: a clinical and arthrographic study. J Bone Joint Surg Br 1983; 65:383–387.

    CAS  PubMed  Google Scholar 

  5. Poeling GG, Ruch DS, Chabon SJ. The landscape of meniscal injuries. Clin Sports Med 1990; 9:539–549.

    PubMed  Google Scholar 

  6. Wright DH, De Smet AA, Norris M. Bucket-handle tears of the medial and lateral menisci of the knee: value of MR imaging in detecting displaced fragments. AJR Am J Roentgenol 1995; 165:621–625.

    CAS  PubMed  Google Scholar 

  7. Helms CA, Laorr A, Cannon WD. The absent bow tie sign in bucket-handle tears of the menisci in the knee. AJR Am J Roentgenol 1998; 170:57–61.

    CAS  PubMed  Google Scholar 

  8. Singson R, Feldman F, Staron R, Kiernan H. MR imaging of displaced bucket-handle tear of the medial meniscus. AJR Am J Roentgenol 1991; 156:121–124.

    CAS  PubMed  Google Scholar 

  9. Weiss KL, Morehouse HT, Levy IM. Sagittal MR images of the knee: a low signal band parallel to the posterior cruciate ligament caused by a displaced bucket handle tear. AJR Am J Roentgenol 1991; 156:117–119.

    CAS  PubMed  Google Scholar 

  10. Watt A, Halliday T, Raby N. The value of the absent bow tie sign in MRI of bucket-handle tears. Clin Radiol 2000; 55:622–626.

    CAS  PubMed  Google Scholar 

  11. Magee TH, Hinson GW. MRI of meniscal bucket-handle tears. Skeletal Radiol 1998; 17:495–499.

    Article  Google Scholar 

  12. Haramati N, Staron RB, Rubin S, Shreck EH, Feldman F, Kiernan H. The flipped meniscus sign. Skeletal Radiol 1993; 22:273–277.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Theodore A. Dorsay.

Additional information

Presented at RSNA 2001 National Meeting, Chicago, Illinois, 26 November 2001

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Dorsay, T.A., Helms, C.A. Bucket-handle meniscal tears of the knee: sensitivity and specificity of MRI signs. Skeletal Radiol 32, 266–272 (2003).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Knee, menisci
  • Knee, MR
  • Magnetic resonance (MR)