Segond fracture: involvement of the iliotibial band, anterolateral ligament, and anterior arm of the biceps femoris in knee trauma

Abstract

Associated findings of Segond fracture include ACL tear, MCL tear, medial meniscus tear, and posterolateral corner injury. Both the ITB and the ALL may be involved in the Segond avulsion. The anterior arm of the biceps femoris tendon is not involved.

Assessment of the Anterolateral Ligament of the Knee by Magnetic Resonance Imaging in Acute Injuries of the Anterior Cruciate Ligament

“…The small ALL thickness and its anatomical variability also difficult the complete visualization. 5,11,12 Helito et al 5 performed a study in 39 patients and identified the ALL in its entirety in around two-thirds of the MRI scans, but additional coronal proton densityeweighted sequences without fat saturation were also used. Taneja et al, 13 in a study of 70 patients, were able to visualize the ALL in its entirety in a very low percentage of the MRI scans, observing some portion of the ligament in around half of the scans.…”

“…Both of these studies found a low percentage of Segond fractures; thus, these fractures cannot be the only indication of ALL injury or associated anterolateral instability. Claes et al 19 suggested that Segond fractures are always related to a bone avulsion of the ALL; however, De Maeseneer et al 11 found that the iliotibial band may also be involved in the genesis of this avulsion. Davis et al 20 identified 2 cases of injury of the knee lateral complex, comprising the ALL and lateral collateral ligament.…”

“…Although MRI is a method with great potential, the injury criteria were established arbitrarily based on the experience of the authors and on previous studies that evaluated this structure. [4][5][6][7][8][9][10][11]19 In addition, no correlation between the lesions in the imaging examinations and the clinical findings was performed, although notably, biomechanical studies have shown the role of the ALL in the genesis of anterolateral instability of the knee. 22 The lack of association between the ALL and the lateral meniscus lesions might be suffering from a type 2 (or beta type) error due to the sample size used and this should also be considered as a limitation of this study.…”

Revisión sistemática: ligamento anterolateral de la rodilla

“…La localización de la inserción tibial del LAL posterior al tubércu-lo de Gerdy (1,(8)(9)(10)(11)39,40) y la frecuente combinación con la lesión del LCA hacen que se haya relacionado la lesión de esta estructura con la fractura de Segond (9,27,28) . La banda iliotibial (5,68,69) , la zona central de la cápsula articular (6,67) , el brazo anterior de la cabeza corta del bíceps femoral (70) y la banda anterior del LCL (5,71) también han sido propuestos como causantes de esta lesión (72) (Figura 4).…”

Anterolateral Ligament (ALL) — Myth or Reality?

“…Therefore, while evaluating the injured knee, one should closely evaluate the anterolateral structures as well. 1,25,43,44 ClINICal aND sURgICal sIgNIFICaNCE Before modern ACL reconstruction techniques were developed, isolated lateral extra-articular procedures were used as the standard surgical techniques in patients with ACL insufficiency. These procedures were non-anatomic, reproduced the biomechanics poorly, and resulted in residual instability and over-constraint of the lateral compartment (with secondary osteoarthritis), thus being abandoned.…”