Objective To detect the value of magnetic resonance imaging (MRI) signs in the diagnosis of bucket-handle meniscal tears of the knee. Patients and methods Fifty-five patients were included in this study whose MRI was read as bucket handle tear. Their ages ranged from 19 to 50 years. All patients had subsequent arthroscopy for surgical confirmation. Results 37 cases were proved as bucket-handle tears (true surgical positive) by arthroscopy and 18 cases were proved as non bucket handle (true surgical negative). The specificities of MRI signs alone were absent bow tie 44.4%, fragment in notch 77.8%, coronal truncation 77.8%, anterior flipped meniscus 88.9%, double PCL 100%, double anterior horn 100%, disproportional posterior horn 100%. The specificity of absent bow tie with fragment in notch was 83.3%, with anterior flipped meniscus was 94.4% and with coronal truncation was 100%. Specificity was 94.4% for combined absent bow tie, fragment in notch, coronal truncation while combined absent bow tie, anterior flipped meniscus, fragment in notch as well as absent bow tie, double anterior horn, fragment in notch revealed 100% specificity. Conclusion MRI is highly specific in diagnosing meniscal bucket handle tears in the knee, particularly, when signs are combined.
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