PDF herunterladen
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2023; 33(02): 157-161
DOI: 10.1055/s-0042-1759859
Original Article

The Pelican Sign: Case Series Demonstrating A Unique Description of an Anteriorly Flipped Bucket-Handle Meniscal Tear of the Knee

Ali Shah 
1   Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
,
Karthikeyan P. Iyengar 
2   Southport and Ormskirk Hospital NHS Trust, Southport, United Kingdom
,
Sai Niharika Gavvala
3   Department of Radiology, Kurnool Medical College, Kurnool, Andhra Pradesh, India
,
Amit Shah
4   Department of Musculoskeletal Radiology, University Hospitals of Leicester, Leicester, United Kingdom
,
David Beale
5   Heath Lodge Clinic, Knowle, United Kingdom
,
Rajesh Botchu
1   Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
› Institutsangaben Funding None.
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Introduction Bucket-handle tears (BHTs) of the menisci are not uncommon and can occur in isolation or in conjunction with other injuries. The torn fragment can be displaced within the intercondylar notch or flipped anteriorly. In case of anterior flipped fragment, appearances of such tears on magnetic resonance imaging (MRI) scan have been described as various signs in literature (for example double posterior cruciate ligament sign, double delta sign) but mostly in the sagittal or coronal planes.

Purpose The aim of this study was to describe a unique ancillary sign that helps to identify this injury on the axial MRI plane where the anterior flipped BHT figuratively resembles a “pelican bird.”

Materials and Methods A retrospective review of MRI sequences of 10 consecutive patients over a 3-month period referred following a traumatic knee injury with anterior flipped meniscal tears was performed. Demographic details, clinical indication, and other associated features on the MRI were correlated following the observation of characteristic MRI appearance of a BHT.

Results All 10 patients (M:F = 7:3) with a mean age of 24.7 (17–38 years) presented following a twisting injury. 6 out of 10 patients had associated soft-tissue injuries in the knee visualized on the MRI. All patients demonstrated the distinctive “pelican bird” sign on the axial sequences of anterior flipped BHT of either menisci. This was not present with BHTs with displaced fragment within the intercondylar notch.

Conclusion We conclude that the “pelican sign” on an axial sequence when present correlates well with a BHT and its anterior displaced/flipped meniscal fragment. This ancillary sign can complement other previously described signs on different MRI sequences used to confirm a displaced BHT.

Keywords

knee injuries - bucket-handle tear - double flipped meniscus sign - lateral meniscus - medial meniscus - magnetic resonance imaging

Informed Consent

Informed consent (patient/guardian), mandatory only for case reports/clinical images—consent was obtained.


Author Contributions

All the authors contributed to conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing and review and editing of the manuscript.




Publikationsverlauf

Artikel online veröffentlicht:
26. Dezember 2022

© 2022. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Dorsay TA, Helms CA. Bucket-handle meniscal tears of the knee: sensitivity and specificity of MRI signs. Skeletal Radiol 2003; 32 (05) 266-272
    CrossrefPubMedGoogle Scholar
  • 2 Saltzman BM, Cotter EJ, Wang KC. et al. Arthroscopically repaired bucket-handle meniscus tears: patient demographics, postoperative outcomes, and a comparison of success and failure cases. Cartilage 2020; 11 (01) 77-87
    CrossrefPubMedGoogle Scholar
  • 3 Ververidis AN, Verettas DA, Kazakos KJ, Tilkeridis CE, Chatzipapas CN. Meniscal bucket handle tears: a retrospective study of arthroscopy and the relation to MRI. Knee Surg Sports Traumatol Arthrosc 2006; 14 (04) 343-349
    CrossrefPubMedGoogle 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 (04) 383-387
    CrossrefPubMedGoogle Scholar
  • 5 Hou JH, Gong YL, Ma P. et al. Comparative clinical outcomes of different therapies for traumatic meniscal tears in adults: a protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2022; 101 (02) e28557 DOI: 10.1097/MD.0000000000028557.
    CrossrefPubMedGoogle Scholar
  • 6 Magee TH, Hinson GW. MRI of meniscal bucket-handle tears. Skeletal Radiol 1998; 27 (09) 495-499
    CrossrefPubMedGoogle Scholar
  • 7 Crawford R, Walley G, Bridgman S, Maffulli N. Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review. Br Med Bull 2007; 84 (01) 5-23
    CrossrefPubMedGoogle Scholar
  • 8 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 (03) 621-625
    CrossrefPubMedGoogle Scholar
  • 9 Haramati N, Staron RB, Rubin S, Shreck EH, Feldman F, Kiernan H. The flipped meniscus sign. Skeletal Radiol 1993; 22 (04) 273-277
    CrossrefPubMedGoogle Scholar
  • 10 Helms CA, Laorr A, Cannon Jr WD. The absent bow tie sign in bucket-handle tears of the menisci in the knee. Am J Roentgenol 1998; 170 (01) 57-61
    CrossrefPubMedGoogle Scholar
  • 11 Ahn JH, Yim SJ, Seo YS, Ko TS, Lee JH. The double flipped meniscus sign: unusual MRI findings in bucket-handle tear of the lateral meniscus. Knee 2014; 21 (01) 129-132
    CrossrefPubMedGoogle Scholar
  • 12 Singson RD, Feldman F, Staron R, Kiernan H. MR imaging of displaced bucket-handle tear of the medial meniscus. Am J Roentgenol 1991; 156 (01) 121-124
    CrossrefPubMedGoogle Scholar
  • 13 Takayama K, Matsushita T, Matsumoto T, Kubo S, Kurosaka M, Kuroda R. The double ACL sign: an unusual bucket-handle tear of medial meniscus. Knee Surg Sports Traumatol Arthrosc 2011; 19 (08) 1343-1346
    CrossrefPubMedGoogle Scholar
  • 14 Al-Ahaidib AA, Alrabai HM, Alajlan A, Al-Shehab Y, Al-Ahaideb AS. The double ACL sign: an aberrant bucket-handle tear of lateral meniscus. Ann Med Surg (Lond) 2020; 54: 93-96
    CrossrefPubMedGoogle Scholar
  • 15 Rao N, Patel Y, Opsha O. et al. Use of the V-sign in the diagnosis of bucket-handle meniscal tear of the knee. Skeletal Radiol 2012; 41 (03) 293-297
    CrossrefPubMedGoogle Scholar
  • 16 Cipolla M, Scala A, Gianni E, Puddu G. Different patterns of meniscal tears in acute anterior cruciate ligament (ACL) ruptures and in chronic ACL-deficient knees. Classification, staging and timing of treatment. Knee Surg Sports Traumatol Arthrosc 1995; 3 (03) 130-134
    CrossrefPubMedGoogle Scholar
  • 17 Nikolić DK. Lateral meniscal tears and their evolution in acute injuries of the anterior cruciate ligament of the knee. Arthroscopic analysis. Knee Surg Sports Traumatol Arthrosc 1998; 6 (01) 26-30
    CrossrefPubMedGoogle Scholar