Segond Fractures Are Not a Risk Factor for Anterior Cruciate Ligament Reconstruction Failure

Gaunder, Christopher; Bastrom, Tracey P.; Pennock, Andrew T.

doi:10.1177/0363546517726962

Cited by 30 publications

(47 citation statements)

References 24 publications

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“…The present data indicated that in 36% of cases, the initial bony avulsion was transformed to a bony sequela at the anterolateral tibia upon the final radiographs. This contrasts the finding of Gaunder et al, 14 where 90% of patients were seen to have a healing response. In that study, the healing response was assessed from initial radiographs and MRI scans to postoperative radiographs only.…”

Section: Discussioncontrasting

confidence: 91%

“…No differences were seen in patientreported outcome measures, knee stability, or return to postoperative level of activity. A study by Gaunder et al 14 investigated the incidence among 552 primary ACL reconstructions, in which 31 displayed a Segond fracture. None of these had a ''graft failure'' during the follow-up period, and the authors concluded that the Segond fracture was not a risk factor for failure after ACL reconstruction.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussioncontrasting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…However, it is important to note that they only used plain radiographs and magnetic resonance imaging (MRI) to detect SF's, which they reported with an incidence of 5.6%. 4 Although this rate is in keeping with other studies 3,5 , it appears that a large proportion of SF's will not have been identified using these modalities. Klos, et al reported a much higher rate of detection (30%) when using ultrasound (US).…”

supporting

confidence: 83%

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

Saithna¹,

Cavaignac²,

Monaco³

et al. 2018

Am J Sports Med

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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."

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“…A recent large retrospective cross-sectional study concluded that SF is not a risk factor for ACL graft failure but did not specifically assess the rate of persistent instability 17. Unfortunately, the study had numerous limitations.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, in this case, the ALL was considered retracted and its signal, path and thickness were difficult to analyse properly. Gaunder et al reported that only 5.3% (29/552) of patients had an avulsion of the anterolateral tibia which suggests that some diagnoses of SF were likely missed 17. Another major limitation was that they did not report the rate of recognised risk factors for ACL graft failure, for example, preoperative side-to side laxity difference, participation in contact sports, age, lateral femoral condyle notching, meniscal injury or an evaluation of tunnel position all of which confound the study.…”

Section: Discussionmentioning

confidence: 99%

Combined ACL reconstruction and Segond fracture fixation fails to abolish anterolateral rotatory instability

Fernandes

Ouanezar²,

Saithna

et al. 2018

BMJ Case Reports

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The Segond fracture (SF) is considered pathognomonic of an anterior cruciate ligament (ACL) tear. However, the anatomy of the soft-tissue attachments responsible for the avulsion of SFs has been a cause of controversy. A 31-year-old male patient presented with an injury to his right knee that resulted in ACL tear and a SF. Open SF fixation and arthroscopic ACL reconstruction were performed. The anatomical dissection demonstrated that the avulsion of SFs had occurred because of the tibial attachment of the anterolateral ligament (ALL) with an intact Iliotibial band. At 1-year postoperative follow-up, the ACL graft had restored anterior tibial translation to within normal limits. However, residual rotational knee laxity was observed. This finding highlights that patients with SF may be at increased risk of persistent instability after ACL reconstruction. Consideration should be given to recession of the fixation or augmentation of the ALL when dealing with this injury pattern.

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Segond Fractures Are Not a Risk Factor for Anterior Cruciate Ligament Reconstruction Failure

Cited by 30 publications

References 24 publications

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

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

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

Combined ACL reconstruction and Segond fracture fixation fails to abolish anterolateral rotatory instability

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