 So, now let's take a case. Here are two axial images, one, the one on your left is, the one on your left is a T2, the one on your right is a fat suppressed 3D. We're going to work our way down to the meniscal level, so we start up high, go down low, and we see a rather bizarre looking configuration, and I'm going to draw it right over the top of it right now and blow it up. Make it a little bigger, and we have this structure here, which you can see over here, and we also have this structure here. And what you're looking at are the native meniscus and a displaced piece of meniscus that has broken off with a gigantic gap in the center. Don't believe me? Let's look at our most favored nation projection for a bucket handle tear, which is the coronal. Let's go to the coronal and scroll it. Now, we said when you have a bucket handle tear, you're going to have a rim, and here is our rim. It's a pretty small rim, isn't it? We might measure the rim from its outer third to its inner tip, and that might be only two or three millimeters, making it very difficult to sew to. So we have a very tiny rim. We said there's going to be a giant hole. Well, here's your giant hole right here. That's your giant hole. And we said we're going to have a piece that is displaced into the center of the knee underneath the posterior cruciate ligament. There is the piece displaced right underneath the posterior cruciate ligament. There's the posterior cruciate ligament. There's the piece immediately underneath it. The so-called double PCL sign. Now, let's scroll it. We go to the back, and all the way in the back, we're actually ripped off. We're missing a piece of the posterior medial corner. There's the meniscus with the meniscus root. Let's go forward. Meniscus, got a little vertical tear in it. At the capsule, there's a fragment. Let's keep going. Meniscus, fragment. Meniscus, fragment. Meniscus, fragment. Meniscus, fragment. And now they're going to come back together again. And there they are. They finally come back together all the way in the front. Now, what else can simulate this? There are two very important simulators of a bucket handle tear. One is an anterior large accessory bundle of the PCL that swings forward like this and inserts on the inside edge of the medial femoral condom. Now, how do you know that's not a fragment? Because it's going to be dark like a ligament or like a meniscus because you can follow it right back to the PCL when you scroll it. That is a major cause of misdiagnosis of bucket handle tear, especially after someone's had a menisectomy. Because now the meniscus looks small. You think, where did it go? You find this extra ligament. You, in your mind's eye, connect the two and you think you got a bucket handle tear, you don't. The menisci have to come back together again or at least oppose each other. The other major cause of misdiagnosis of a discord meniscus is this. If you've got a very tightly C-shaped meniscus and you perform a coronal projection on at least a couple of cuts, you're going to get a meniscus, then a hole, then a meniscus. But that hole is just a normal curve. That's the normal cartilage surface. And if you have a little synovitis in there, it might have a little fluid with it. So it's going to look like a little hole right there. And then on the next cut, you might have the same thing, but then it suddenly goes away. It looks normal again. And then you go up to the next cut and all you see is a triangle. And it never separates maybe from more than two cuts. So when you have a very tight C-shaped meniscus, that can simulate a bucket handle tear. Finally, let me just show you the sagittal just for completion's sake. Here's our sagittal. We'll blow it up a little bit. Here's our lateral meniscus. Let's go over to the medial side. We said that we were going to have a rectangular-shaped or linear-shaped structure that's extra. Well, here it is right here. This one's a little arc-shaped. It sits right underneath the PCL, the so-called double-PCL sign of a bucket handle tear. And we go over to our medial meniscus and our rim is pretty darn small. How does our rim look? Not so good. If you look very carefully, there's a big vertical tear in the back of our rim. There's another small vertical tear. There's some complex signal posteriorly. There's some complex signal anteriorly. Let's keep going. Oh, there's two structures there, just like we said. Double anterior meniscus sign because a portion of this bucket handle tear has pushed forward. In fact, the portion that's pushed forward is here. The native meniscus is shoved all the way in the front. So in this example, you've got something that looks like this. You've got your bucket that's pushed forward. There's your native meniscus. And here's your big hole. So there is your double meniscus sign. Native meniscus shoved anteriorly. Bucket handle fragment pushed anteriorly. Double anterior horn sign of a bucket handle tear. So that concludes our discussion of bucket handle tears. You've got the central type. You've got the anterior extended type. You've got the posterior extended type. You've got the complete free fragment type. The bucket fragment can twist. It can migrate. But when it migrates, it usually does so anteriorly. The classic bucket will go underneath the posterior crucian ligament. It's important to assess the rim thickness and whether the fragment that you're trying to sew to itself also has a tear. And one final caveat. People that get bucket handle tears they usually have some form of niloxity. The most common form, ACL deficiency. This patient had a graft. The graft is attenuated proximally. In fact, it's torn as it enters a femur. This is an ACL deficient D. They go together like soup and sandwich. Bucket handle tear and ACL deficiency. Very common. BDL is more common. It's about 60, 40. Yeah. Not uncommon.