High prevalence of all complex Segond avulsion using ultrasound imaging

Klos, Burt; Scholtes, Marlon; Konijnenberg, Stephan

doi:10.1007/s00167-017-4532-8

Cited by 29 publications

(38 citation statements)

References 23 publications

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“…Radiographs are considered the gold standard when investigating Segond fractures, 8 but as discussed formerly, the use of other radiological modalities might help establish the relationship between this bony avulsion and the high incidences of ALC soft tissue injuries. 19,22 Given that very few studies have related clinical evaluation of anterolateral rotational instability to imaging signs of anterolateral injury, the clinical correlate of the Segond fracture still has to be settled. Another limitation of the current work is the slight change in surgical techniques throughout the study period.…”

Section: Discussionmentioning

confidence: 99%

“…6,13 Other authors have studied the bony avulsion with ultrasound and suggested that dynamic ultrasound might be used to better visualize associated ligament injury. 19 With the recent debate on anatomic features and biomechanical properties of the anterolateral complex, including the anterolateral ligament, new light has been shed on the potential importance of injuries to the anterolateral aspect of the knee. 12,13,18 Some authors have questioned if the Segond fracture represents a bony avulsion of the tibial anterolateral ligament insertion.…”

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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: Discussionmentioning

confidence: 99%

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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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“…The authors used only plain radiographs and MRI to evaluate for the presence of SF. However, it is recognised that these imaging modalities are not as sensitive as ultrasound, which detects SF at a rate of approximately 30% in ACL injured knees 8. From proximal to distal, several portions of the ALL can be injured 18.…”

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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“…Klos et al reported a much higher rate of detection (30%) when using US. 11 Cavaignac et al found a large difference in the detection rate of Segond lesions based on plain radiographs (3.3%), MRI (13%) and US (50%). 1 Ultrasonography makes it possible to detect a certain number of Segond fractures that are not fractures by definition, but actually unicortical lesions over the ALL's tibial insertion.…”

mentioning

confidence: 96%

Is Treatment of Segond Fracture Necessary With Combined Anterior Cruciate Ligament Reconstruction? Letter to the Editor

Cavaignac¹,

Saithna²,

Monaco³

et al. 2018

Am J Sports Med

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High prevalence of all complex Segond avulsion using ultrasound imaging

Abstract: IV.

Cited by 29 publications

References 23 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

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

Is Treatment of Segond Fracture Necessary With Combined Anterior Cruciate Ligament Reconstruction? Letter to the Editor

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