PMC7505755_01
Stable grade III meniscal undersurface tear with horizontal cleavage of the posterior medial meniscus on A) sagittal and B) coronal DP FS images, without any signs of meniscal instability or ramp lesion.
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ACL tear (with a differential of 4 mm on the KT-1000 anterior tibial translation device) on clinical exam, no pivot-shift and a negative McMurray's test on both menisci. An MRI has been performed thereafter and found a grade III meniscal injury of the medial posterior horn (Fig. 1A) with a horizontal cleavage (Fig. 1B), a normal ACL signal (Fig. 2A), no bone marrow oedema and a buckled PCL of 100  (Fig. 2B).
Visualisation on DP FS images of the A) normal signal and morphological appearance of the ACL however with the B and C) buckling of the PCL (100 ) on sagittal DP FS, showing the spontaneous anterior drawer of the tibia in the prone position during MRI acquisition.
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ACL tear (with a differential of 4 mm on the KT-1000 anterior tibial translation device) on clinical exam, no pivot-shift and a negative McMurray's test on both menisci. An MRI has been performed thereafter and found a grade III meniscal injury of the medial posterior horn (Fig. 1A) with a horizontal cleavage (Fig. 1B), a normal ACL signal (Fig. 2A), no bone marrow oedema and a buckled PCL of 100  (Fig. 2B).
A-C - Locked bucket handle tear of the medial meniscus in the intercondylar notch (DP FS forte); note the double PCL sign (A) and absent bow-tie (B) signs on the sagittal plane, and the fragment in notch sign (C: abnormal presence of three elements in the intercondylar notch) on the coronal plane.
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The MRI performed a few days later found a medial meniscal bucket handle tear (Fig. 3A, B and C).
Not the slight hyperintense ligament signal of the ACL (A), with normalization of the PCL angle (B and C, DP FS forte) compared to Fig. 2B and C.
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The PCL angle was 130  (Fig. 4A), and the ACL showed a slightly inhomogeneous hyperintense signal without clear signs of disrupted fibres or fragmentation (Fig. 4B).
Intra-operative arthroscopic picture of partially detached ACL, with loss of tension. Slight intratendinous hematoma visible, however with no obvious fresh ACL rupture.
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After reduction and the sutures to the medial meniscus, the ACL showed complete loss of tension (Fig. 5), and therefore simultaneous ACL reconstruction was performed by the first author.