Anterior Cruciate Ligament Pathology as a Predisposing Factor for Bucket Handle Meniscal Tear

Objective. To test if the presence of anterior cruciate ligament pathology is a predisposing factor for the occurrence of a bucket handle tear of the meniscus. Materials and methods. In a retrospective double-center setting, 3340 consecutive knee MRI examinations dated between October 2018 and March 2021 with various 1.5 and 3T MRI machines have been reviewed. All cases with bucket-handle tear of the meniscus have been sought. From the bucket handle cases, only those with available previous MRI examinations showing unremarkable meniscus were included. Results. From the evaluated 3340 knee MRI-scans, 36 cases with bucket handle tears were identified (30 and 6 cases involving the medial and lateral meniscus, respectively). Nine out of 36 cases had previous MRI-scan with a non-tear status of the involved meniscus. Interestingly, all these nine cases showed a clear anterior cruciate ligament abnormality prior to the occurrence of bucket handle tear. The nature of the associated anterior cruciate ligament pathology ranged from complete and previous reconstruction in tear in 3 and 6 cases, respectively. Conclusion. A significant association between underlying anterior cruciate ligament pathology and later development of bucket handle tears of the meniscus could be shown. This result highlights the importance of the proprioceptive role of the anterior cruciate ligament in maintaining knee stabilization which can results in further structural meniscal injuries and therefore underlining the necessity of addressing the menisci during its anterior cruciate reconstruction and the importance of their clinical and radiological follow-up