Displaced bucket handle tears of the medial meniscus masking anterior cruciate deficiency

Traditionally, anterior cruciate ligament (ACL) injuries have been difficult to diagnose in the Casualty Department. Studies have shown that the anterior drawer test has a poor sensitivity both in acute and chronic ACL deficient knees 4, 6, 9]; thus, more emphasis has been placed on the pivot shift and Lachman tests 3]. We report four cases of proven ACL rupture where clinical examination revealed an absent pivot shift and a near normal Lachman test following a displaced bucket handle tear of the medial meniscus. This finding has been reproduced in cadaver studies, and we conclude that if the history strongly suggests an ACL injury and examination reveals a stable knee, then the dual pathology of medial meniscus tear and ACL rupture should be suspected.