Segond Fractures Are Not a Risk Factor for Anterior Cruciate Ligament Reconstruction Failure: Letter to the Editor

Abstract

We read the article entitled "Segond Fractures Are Not a Risk Factor for Anterior Cruciate Ligament Reconstruction Failure" by Gaunder, et al. with great interest and congratulate the authors on their work. 4 Although the sequelae of Segond fractures in the anterior cruciate ligament (ACL) injured knee have not yet been fully elucidated this is an important topic for study because of the biomechanical consequences of this injury. Monaco, et al. demonstrated in a cadaveric navigation study that the presence of Segond fracture (SF) was associated with significantly greater anterior tibial translation and axial tibial rotation during the pivot shift test in ACL injured knees. 8 These findings support the study hypothesis reported in the current study, "that patients undergoing revision ACL reconstruction would have a higher incidence of Segond fractures compared with those undergoing primary reconstruction."

Editorial Commentary: The Segond Fracture Has Multiple Attachments: Yet Another Demonstration of the Anatomical Complexity of the Anterolateral Complex of the Knee

“…1 In addition, the Segond fracture has classically been diagnosed on radiographs, which are less sensitive than MRI and ultrasound. [11][12][13] These are valid critiques. However, it must also be recognized that additional structures beyond the ALC are also frequently damaged in ACL injuries, structures of known importance for knee stability.…”

“…That said, it has been appropriately argued that cohort studies may be inherently limited by confounding differences between groups, compromising the strength of conclusions. [11][12][13] To more definitively determine whether treatment of the Segond fracture is clinically beneficial requires a prospective randomized study in which all enrolled patients have a combined ACL injury and Segond fracture. To date, this study has not been performed.…”

Editorial Commentary: Knee Anterolateral Ligament Bashing—Why So Much Negativity?

“…As previously stated, the imaging protocol is critical and can explain variations in interpretation. [5][6][7] The authors also showed a relationship between ALL lesions and the presence and intensity of injured lateral structures (particularly bone bruise). The correlation between ALL lesions and the PST was r ¼ 0.087 (P ¼ .463).…”