Segond fracture in an adult is not pathognomonic for ACL injury

Wharton, Rupert; Henckel, Johann; Bhattee, Ghias; Ball, Simon; Church, Sam

doi:10.1007/s00167-014-2965-x

Cited by 12 publications

(8 citation statements)

References 25 publications

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“…We believe that due to the biomechanical differences previously discussed, the injury resulted in no other significant pathology. While the cases cited above relating to pediatric patients suggest that a Segond fracture without associated ACL tear may not be uncommon [3,[7][8][9], completely isolated Segond fractures have not been frequently documented.…”

Section: Discussionmentioning

confidence: 96%

“…Our case raises issues of mechanism of injury as well as differences in the pediatric versus adult pathoanatomy relative to sports injuries of the knee. It is well known that the Segond fracture can occur without an ACL tear [3,7,8]. However, the presence of a lateral capsular sign will invariably be associated with some other injury to the knee [3,[7][8][9].…”

Section: Discussionmentioning

confidence: 99%

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Isolated Segond fracture in a pediatric patient

Ringenberg

Sealy

Tiller

2015

The Physician and Sportsmedicine

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Physicians diagnosing and managing knee injuries have become familiar with the lateral capsule sign, or Segond fracture on radiography. The Segond fracture is considered highly suggestive of an anterior cruciate ligament (ACL) tear in the adult population. This conclusion is not as well described in the pediatric patient. Recent anatomic studies have confirmed the presence of the anterolateral ligament (ALL), a structure described by Dr. Segond, and hypothesized to be the etiology of the lateral capsular avulsion. Although case reports of Segond fractures with an intact ACL in pediatric patients have been presented, there is usually a concomitant rotatory instability, tendinous injury, physeal fracture or posterolateral disruption. It is not currently clear the role that the ALL plays in the setting of Segond fracture with an intact ACL. We present a case of an isolated Segond fracture and briefly review the literature relating to this diagnosis. The literature suggests that a Segond fracture without an ACL tear is more common in the pediatric age group compared to adults. Our unique case is the presence of an isolated Segond fracture in a pediatric athlete.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Isolated Segond fracture in a pediatric patient

Ringenberg

Sealy

Tiller

2015

The Physician and Sportsmedicine

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“…23,29,31 Also, although cadaveric studies have suggested that internal rotation and varus strain might be part of the injury mechanism, the exact forces needed to create the avulsion are largely unknown. 2,6,17,30 Whereas conventional radiographs have been considered the gold standard for describing Segond fractures, other radiological modalities have provided new and additional information on the size and location of the lesion. 13,19 In a study by Flores et al, 13 bony avulsions were quantified on magnetic resonance imaging (MRI).…”

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confidence: 99%

Incidence and Prognostic Significance of the Segond Fracture in Patients Undergoing Anterior Cruciate Ligament Reconstruction

et al. 2020

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Background: The Segond fracture is an avulsion of the anterolateral tibia that can be found in patients with an anterior cruciate ligament (ACL) tear. It is currently unclear if the Segond fracture needs treatment or if it heals spontaneously and if it is associated with an increased risk of failure after ACL reconstruction.Purpose: To identify the incidence and spontaneous healing rate of Segond fractures in a consecutive cohort of patients undergoing ACL reconstruction and to examine the predictive value of the Segond fracture on the risk of undergoing revision surgery.Study Design: Cohort study; Level of evidence, 3. Methods:A retrospective review of a cohort undergoing isolated ACL reconstruction between 2002 and 2016 was performed. Radiographs from the time of injury and preoperative radiographs were evaluated for Segond fractures and healed Segond fractures. Descriptive data were extracted from an internal quality database. Statistical analyses were performed to investigate risk of revision surgery and to compare across subgroups of patients.Results: A total of 1364 patients were included in the study. The incidence of Segond fractures was 7.4%. In addition, 10.4% of patients displayed signs of healed Segond fractures. In total, 15.2% of patients had either 1 or both findings. The overall healing response of the fracture was 35.6%. Those with Segond fractures were older (P = .014) and had a shorter interval from injury to surgery (P = .003) as compared with the rest of the cohort. The incidence of Segond fractures was significantly higher in those injured during downhill skiing as compared with other injury mechanisms (P = .04). The Segond fracture did not represent an increased risk of undergoing revision when compared with the control group (not significant). Conclusion:The incidence of conventional Segond fractures in patients with ACL injury was found to be in accordance with former studies. Accounting for the high incidence of healed Segond fractures, a much higher incidence (15%) was seen. Although the spontaneous healing rate from initial radiographs to preoperative imaging was only 36%, the presence of Segond fractures did not represent a higher risk of undergoing revision surgery.

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“…Gottsegen et al [20] and DeLee et al [21] reported the Segond fracture combined to popliteal tendon avulsion and iliotibial band avulsion. Wharton et al [26] published a case report in which the Segond fracture was combined to posterolateral ligament injury without ACL rupture. Furthermore, Ferreira reported an absolute isolated Segond fracture.…”

Section: Injurymentioning

confidence: 99%

Decision-Making for ALL Reconstruction and Surgical Techniques

Gürpınar¹

2020

Knee Surgery - Reconstruction and Replacement

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The anterolateral ligament (ALL), which was first described in 1879, was reintroduced in 2013 by Claes et al. It originates near the lateral epicondyle of the distal femur, runs along the lateral outer aspect of the knee, and inserts on the proximal tibia between Gerdy's tubercle and fibular head. The ALL tightens when the knee is internally rotated (twisted inwards), and in doing so, it is proposed to be a stabilizer to internal tibial rotation. Biomechanical studies showed that the ALL restrains internal rotation of the tibia and thus affects the pivot-shift phenomenon in the anterior cruciate ligament (ACL)-injured knee. Therefore, it is proposed that the deficient ALL can be a reason for persistent rotatory instability after ACL reconstruction. Furthermore, ALL reconstruction techniques have evolved and indications extended. Commonly accepted indications for concomitant ACL and ALL reconstruction are ACL revisions, high-grade pivot-shift test, chronic ACL rupture, and young patients and patients doing pivoting activities. Most surgeons perform an anatomic reconstruction technique with gracilis autograft. However, only few studies published reporting the outcomes of ALL reconstruction and more studies with longer follow-up times are, therefore, needed to provide the compelling clinical evidence for the efficacy of concomitant ACL and ALL procedures.

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Segond fracture in an adult is not pathognomonic for ACL injury

Cited by 12 publications

References 25 publications

Isolated Segond fracture in a pediatric patient

Isolated Segond fracture in a pediatric patient

Incidence and Prognostic Significance of the Segond Fracture in Patients Undergoing Anterior Cruciate Ligament Reconstruction

Decision-Making for ALL Reconstruction and Surgical Techniques

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