The ＂tractor trailer＂ sign of traumatic both medial and lateral bucket-handle meniscal tears on the same knee - A case report

Abstract

Most traumatic bucket handle knee meniscal tear is unilateral, either medial or lateral, and often associated with various degree injury of anterior cruciate ligament (ACL). However, simultaneous injury of both medial and lateral menisci on the same knee is very rare. We reported a case of both medial and lateral traumatic bucket handle meniscal tears on the same knee. The magnetic resonance images (MRIs) could demonstrate both medial and lateral bucket-handle meniscal fragments displaced into the inter-condylar notch. Quadruple sign was noted in three consecutive coronal MRIs, demonstrating four structures in the inter-condylar notch: the ACL, posterior cruciate ligament (PCL) and both the medial and lateral bucket-handle meniscal fragments. The mid oblique sagittal MRIs demonstrated both the displaced medial and lateral bucket-handle meniscal fragments in the inter-condylar notch, appearing like as a ＂tractor trailer.＂ Under arthroscopic examination, the ACL was congested, edematous but grossly intact. Attempted reduction of both medial and lateral displaced bucket handle meniscal fragments failed. Arthroscopic medial and lateral partial meniscectomy was then performed. At a follow-up examination one year later, the knee was relatively stable with no instability. The range of motion was full and free. No local pain and tenderness was noted. The patient was instructed to avoid heavy work to prevent early osteoarthritis.