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Yahyazadeh H, Haghbin M, Elahifar O. Simultaneous Medial and Lateral Bucket-handle Meniscus Tears in Chronic ACL Deficiency: A Rare Case of the Triple-PCL Sign. JROS 2023; 10 (3) :161-166
URL: http://jros.iums.ac.ir/article-1-2253-en.html

Background: Bucket-handle meniscus tears are a common yet severe knee injury, often associated with anterior cruciate ligament (ACL) damage. While isolated bucket-handle tears (BHT) are well-documented, simultaneous medial and lateral BHTs are rare, particularly in chronic ACL-deficient knees. The term "triple posterior cruciate ligament (PCL) sign" arises due to the lack of overlap between the two BHTs in the coronal plane while positioned in the intercondylar notch, preventing them from aligning within the same sagittal plan.
Case Presentation: In this report, we present a case of triple PCL sign on magnetic resonance imaging (MRI) in a patient with bilateral lateral and medial bucket handle tears and associated chronic ACL rupture. The patient underwent diagnostic and therapeutic arthroscopy, which confirmed bimeniscal bucket handle tears ‎and their fragments’ entrapment in the intercondylar notch, along with ACL rupture‎. 
Conclusion: This report highlights the diagnostic importance of the triple PCL sign because it is observed in patients with both compartment meniscus tears adjunct to ACL rupture. It also raises awareness of the need to pay more attention to this sign in patients presented with ACL rupture ‏symptoms because it is crucial for preoperative planning.