20 y/o with pivoting injury presented with mechanical lockin | Figure 1

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20 y/o with pivoting injury presented with mechanical locking. This view shows classic double PCL sign associated with bucket handle medial meniscus tear. Orange arrow is normal PCL. Blue arrow is meniscus flipped back into the joint.

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Most likely diagnosis:\n(1) Bucket-handle tear within lateral meniscus\nFrom the sagittal and coronal images provided, no synovitis is identified, thus idiopathic arthrosis is excluded.\nPediatric anterior cruciate ligament tears are uncommon. Juvenile idiopathic arthritis (JIA) is associated with synovitis.\nIn image 5 (green arrows), note capsular disruption and retrofemoral swelling, especially laterally.\nIn image 6 (green arrows), there is reactive myoedema along the course of the popliteus muscle.\nIn image 7, multiple findings stand out:\nA small tear of the popliteofibular ligament (pink arrows)\nDisrupted meniscocapsular fascicles in the posterior horn, lateral meniscus (orange arrows)\nThe yellow arrow demonstrates the torn and anteriorly displaced posterior horn ("rim") of the lateral meniscus in front of the anterior horn.\nIn image 8, note the small remnant midbody lateral meniscus (red arrow) versus normal medial meniscus (purple arrow). The blue arrow shows the medially displaced fragment of the bucket handle tear in the intercondylar notch.