Bucket Handle Tear of the Medial Meniscus with a New Magnetic Resonance Imaging Sign: The “Head in the Sand Sign” – A Case Report

Introduction: Bucket handle tears of the meniscus are frequently diagnosed using magnetic resonance imaging (MRI), with classical signs such as the double posterior cruciate ligament sign and the absent bow-tie sign aiding recognition. However, atypical fragment orientations may obscure these features. We describe a new MRI sign—the “Head in the Sand sign”—seen in a medial meniscus bucket handle tear. Case Report: A 20-year-old male presented with right knee pain, locking, and restricted flexion after a twisting injury. MRI revealed a displaced bucket handle tear of the medial meniscus. In addition to typical findings, a novel MRI configuration was observed: The displaced fragment formed an inverted U-shape with the posterior horn, resembling the posture “Head in the Sand sign.” Arthroscopy confirmed a bucket handle tear with intact articular cartilage and cruciate ligaments. Meniscal repair was performed using an all-inside technique. The patient regained a full range of movements by 6 weeks. Conclusion: The “Head in the Sand sign” is a newly described MRI sign that may assist in diagnosing medial meniscus bucket handle tears when classical findings are subtle or absent. Keywords: Arthroscopy, meniscus, bucket handle tear, knee, magnetic resonance imaging.