Purpose
To evaluate the magnetic resonance imaging (MRI) characteristics of Segond fractures,
including the structures attached to the avulsed fragment, the integrity of anterolateral
ligament (ALL) and iliotibial band (ITB), and fragment size and location.
Methods
This was a retrospective, cross-sectional study with MRI scans from 2016 to 2019 with
the term “Segond” in the reports, signs of acute trauma, and a bony anterolateral
tibial avulsion (Segond) fracture. Two experienced observers accessed images to evaluate
fragment dimensions (anteroposterior, mediolateral, and craniocaudal) and distances
from anatomic landmarks (Gerdy’s tubercle, articular surface, and posterolateral tibial
corner). ALLs and ITBs also were evaluated, both for integrity and for attachment
to the avulsed bony fragment. Data were statistically evaluated for significant correlations.
Results
Forty-eight knee MRIs of patients suffering from a combined anterior cruciate ligament
and Segond injury were evaluated. The ALL presented with edema in 28 cases (58.3%)
and was torn in 3 cases (6.3%). The ALL was attached to the bone fragment in all cases
and the ITB also was attached in 25 cases (52.1%). Receiver operating characteristic
curves also demonstrated that the larger each of the dimensions and the volume of
the fragment, the greater the probability of ITB fibers being inserted. Also, the
narrower the distance from the fragment to the center of Gerdy’s tubercle, the greater
the probability of iliotibial band fibers being attached. Interobserver correlation
varied from 0.87 to 0.97 for all measurements.
Conclusions
In all combined ACL injuries and Segond fracture MRI cases, the complete ALL inserted
on the avulsed bony fragment, whereas the posterior part of the ITB was only attached
in 52.1% of the cases. Segond fracture fragment size was predictive for the structures
attached to it. The ALL was abnormal in 64.5% of cases and presented a clear discontinuity
in 6.3%.
Level of Evidence
Case Series, Level IV.
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References
- Recherches cliniques et experimentales sur les epanchements sanguins du genou par entorse.Prog Med. 1879; 7 (319-321, 340-341): 297-299
- Avulsion fractures of the knee: Imaging findings and clinical significance.Radiographics. 2008; 28: 1755-1770
- The Segond fracture of the proximal tibia: A small avulsion that reflects major ligamentous damage.AJR Am J Roentgenol. 1988; 151: 1163-1167
- Pathogenesis of the Segond fracture: Anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion.Radiology. 2013; 219: 381-386
- Segond fractures: Not necessarily pathognemonic of anterior cruciate ligament injury in the pediatric population.Sports Health. 2010; 2: 437-439
- Segond fracture in an adult is not pathognomonic for ACL injury.Knee Surg Sport Traumatol Arthrosc. 2015; 23: 1925-1928
- The anterolateral complex of the knee: Results from the International ALC Consensus Group Meeting.Knee Surg Sport Traumatol Arthrosc. 2019; 27: 166-176
- Segond fracture: Involvement of the iliotibial band, anterolateral ligament, and anterior arm of the biceps femoris in knee trauma.Skeletal Radiol. 2015; 44: 413-421
- Segond tibial condyle fracture: Lateral capsular ligament avulsion.Radiology. 2014; 159: 467-469
- Segond fracture: An MR evaluation of 146 patients with emphasis on the avulsed bone fragment and what attaches to it.Skeletal Radiol. 2016; 45: 1635-1647
- The iliotibial tract; clinical and morphological significance.J Bone Joint Surg Am. 1958; 40A: 817-832
- The iliotibial band and anterolateral capsule have a combined attachment to the Segond fracture.Knee Surg Sport Traumatol Arthrosc. 2018; 26: 1305-1310
- The anterolateral ligament of the knee: MRI appearance, association with the segond fracture, and historical perspective.AJR Am J Roentgenol. 2015; 204: 367-373
- The iliotibial tract: Imaging, anatomy, injuries, and other pathology.Skeletal Radiol. 2017; 46: 605-622
- The segond fracture: A bony injury of the anterolateral ligament of the knee.Arthroscopy. 2014; 30: 1475-1482
- An anatomic study of the iliotibial tract.Arthroscopy. 2007; 23: 269-274
- Characterization of the anatomy of the anterolateral ligament of the knee using magnetic resonance imaging.Skeletal Radiol. 2015; 44: 1647-1653
- A cadaveric study of the anterolateral ligament: Re-introducing the lateral capsular ligament. Knee Surgery.Sport Traumatol Arthrosc. 2015; 23: 3186-3195
- MRI evaluation of the anterolateral ligament of the knee: Assessment in routine 1.5-T scans.Skeletal Radiol. 2014; 43: 1421-1427
- High prevalence of anterolateral ligament abnormalities in magnetic resonance images of anterior cruciate ligament-injured knees.Acta Orthop Belg. 2014; 80: 45-49
- Anatomy of the anterolateral ligament of the knee.J Anat. 2013; 223: 321-328
- An overview of anatomy and imaging of the anterolateral structures of the knee.Tech Orthop. 2018; 33: 206-212
- The magnetic resonance imaging appearance of the anterolateral ligament of the knee in association with anterior cruciate rupture.Skeletal Radiol. 2017; 46: 1193-1200
- Anterolateral ligament of the knee: Anatomy, Function, imaging, and treatment.Am J Sports Med. 2018; 46: 217-223
- Anterolateral ligament abnormalities in patients with acute anterior cruciate ligament rupture are associated with lateral meniscal and osseous injuries.Eur Radiol. 2016; 26: 3383-3391
- Assessment of the anterolateral ligament of the knee by magnetic resonance imaging in acute injuries of the anterior cruciate ligament.Arthroscopy. 2017; 33: 140-146
- Magnetic resonance imaging of the knee: An overview and update of conventional and state of the art imaging.J Magn Reson Imaging. 2017; 45: 1257-1275
- Anterolateral ligament reconstruction is associated with significantly reduced ACL graft rupture rates at a minimum follow-up of 2 years: A prospective comparative study of 502 patients from the SANTI Study Group.Am J Sports Med. 2017; 45: 1547-1557
- Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament–deficient knee.J Orthop Traumatol. 2017; 18: 91-106
- Anatomic reconstruction of the anterior cruciate ligament of the knee with or without reconstruction of the anterolateral ligament: A randomized clinical trial.Am J Sports Med. 2017; 45: 1558-1566
- Reconstructing the anterolateral ligament does not decrease rotational knee laxity in ACL-reconstructed knees.Knee Surg Sport Traumatol Arthrosc. 2017; 25: 1125-1131
- Combined anterior cruciate ligament repair and anterolateral ligament reconstruction.Arthrosc Tech. 2019; 8: e23-e29
- Combined anterior cruciate and anterolateral ligament reconstruction in the professional athlete: Clinical outcomes from the scientific anterior cruciate ligament network international study group in a series of 70 patients with a minimum follow-up of 2 years.Arthroscopy. 2019; 35: 885-892
- Combined reconstruction of the anterolateral ligament in chronic ACL injuries leads to better clinical outcomes than isolated ACL reconstruction.Knee Surg Sport Traumatol Arthrosc. 2018; 26: 3652-3659
- Clinical outcomes of isolated revision anterior cruciate ligament reconstruction or in combination with anatomic anterolateral ligament reconstruction.Am J Sports Med. 2019; 47: 324-333
- Surgical treatment of segond fractures in acute anterior cruciate ligament reconstruction.Orthop J Sport Med. 2017; 5: 1-6
- Is treatment of segond fracture necessary with combined anterior cruciate ligament reconstruction? Letter to the editor.Am J Sports Med. 2018; 46: NP13-NP14
- The influence of segond fracture on outcomes after anterior cruciate ligament reconstruction.Arthroscopy. 2018; 34: 1900-1906
- Is treatment of segond fracture necessary with combined anterior cruciate ligament reconstruction?.Am J Sports Med. 2018; 46: 832-838
- Combined ACL reconstruction and Segond fracture fixation fails to abolish anterolateral rotatory instability.BMJ Case Rep. 2018; 2018 (bcr-2018-224457)
- Tip-of-the-iceberg fractures: Small fractures that mean big trouble.AJR Am J Roentgenol. 2015; 205: 524-532
- Surgical indications for anterior cruciate ligament reconstruction combined with extra-articular lateral tenodesis or anterolateral ligament reconstruction.Rev Bras Ortop. 2018; 53: 661-667
- Segond fractures are not a risk factor for anterior cruciate ligament reconstruction failure.Am J Sports Med. 2017; 45: 3210-3215
- Why do authors differ with regard to the femoral and meniscal anatomic parameters of the knee anterolateral ligament? Dissection by layers and a description of its superficial and deep layers.Orthop J Sport Med. 2016; 4 (232596711667560)
- Anterolateral ligament abnormalities are associated with peripheral ligament and osseous injuries in acute ruptures of the anterior cruciate ligament.Knee Surg Sport Traumatol Arthrosc. 2017; 25: 1140-1148
- The Segond fracture is an avulsion of the anterolateral complex.Am J Sports Med. 2017; 45: 2247-2252
Article info
Publication history
Published online: February 13, 2020
Accepted:
February 1,
2020
Received:
September 10,
2019
Footnotes
See commentary on page 1687
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2020 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: The Segond Fracture Has Multiple Attachments: Yet Another Demonstration of the Anatomical Complexity of the Anterolateral Complex of the KneeArthroscopyVol. 36Issue 6
- PreviewThe anterolateral complex (ALC) of the knee comprises multiple layers, with continued debate on the identity and function of the structures of the ALC. The Segond fracture, long considered pathognomonic of an anterior cruciate ligament injury, has now been shown to have several attachments to soft tissues of the ALC. To the extent that a Segond fracture, or injury to the ALC more broadly, increases knee rotatory instability in vivo is a question of ongoing investigation. By extension, it remains uncertain whether an untreated Segond fracture adversely affects outcomes and therefore warrants consideration for operative intervention.
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