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

Cavaignac, Étienne; Saithna, Adnan; Monaco, Edoardo; Helito, Camilo Partezani; Daggett, Matthew; Reina, Nicolas; Sonnery‐Cottet, Bertrand

doi:10.1177/0363546518764420

Cited by 14 publications

(17 citation statements)

References 15 publications

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“…5,8,15 The ALL was considered injured if it was not continuous over its entire length or if it was avulsed from its tibial insertion (true Segond fracture or ultrasonographic Segond lesion). 7 Dynamic testing in internal rotation was conducted to improve the ability to check ligament continuity. 4 A detailed description of the reconstruction techniques and the product names for all of the fixation devices are available in the Appendix.…”

Section: Methodsmentioning

confidence: 99%

Effect of Lateral Extra-articular Tenodesis on Anterior Cruciate Ligament Graft Incorporation

Cavaignac

Mesnier

Marot

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: It has been shown that adding lateral extra-articular tenodesis (LET) to standard anterior cruciate ligament (ACL) reconstruction significantly decreases the loads on the ACL composite graft. To date, the possible effect of LET on ACL graft incorporation is not known. Purpose: To compare the incorporation in tibial bone tunnels of a standard quadrupled semitendinosus (ST4) graft to an ST4 graft plus LET at 1 year postoperatively using magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence, 3. Methods: A total of 62 patients who underwent ACL reconstruction were enrolled prospectively: 31 received an ST4 graft, and 31 received an ST4 graft plus LET. Graft incorporation was evaluated with MRI at the 1-year follow-up visit. The following parameters were evaluated: signal-to-noise quotient (SNQ), tibial tunnel widening, graft healing, and graft maturity according to the Howell scale. The primary endpoint was the SNQ of the ST4 graft at 1 year postoperatively; this parameter was adjusted because of unequal baseline characteristics between groups. Clinical and functional outcomes as well as incorporation of the graft were analyzed as secondary endpoints. Results: The mean adjusted SNQ was 0.5 ± 2.1 (95% CI, 0.4-4.6) in the ST4 + LET group and 5.9 ± 3.7 (95% CI, 4.7-7.0) in the ST4 group ( P = .0297). The mean tibial tunnel widening was 73.7% ± 42.2% in the ST4 + LET group versus 77.5% ± 46.7% in the ST4 group ( P = .5685). Howell grade I, indicative of better graft maturity, was statistically more frequent in the ST4 + LET group ( P = .0379). No statistically significant difference was seen between groups in terms of graft healing ( P = .1663). The Lysholm score was statistically higher in the ST4 + LET group ( P = .0058). No significant differences were found between groups in terms of the International Knee Documentation Committee subjective score ( P = .2683) or Tegner score ( P = .7428). The mean SNQ of the LET graft at the 1-year follow-up visit was 2.6 ± 4.9. Conclusion: At 1 year postoperatively, the MRI appearance of ACL grafts showed generally better incorporation and maturation when combined with LET.

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Section: Methodsmentioning

confidence: 99%

Effect of Lateral Extra-articular Tenodesis on Anterior Cruciate Ligament Graft Incorporation

Cavaignac

Mesnier

Marot

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…However, Melugin et al [28] reported that patients undergoing ACLR with and without a Segond fracture had similar pivotshift test results, graft failure rates, and activity levels. Cavaignac et al [8] proposed that the lack of difference found in the Melugin study could be due to analysis bias, selection bias, and interpretation bias. The most important point raised by Cavaignac is that the term Segond fracture should be reserved for bony avulsions seen on plain radiographs, rather than on MRI and ultrasonography.…”

Section: Discussionmentioning

confidence: 98%

Surgical Treatment for Avulsion Fractures of the Anterolateral Ligament Associated with Periarticular Fractures of the Knee

Wei

Wang

et al. 2020

Preprint

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Background: To confirm the existence of the ALL and evaluate the clinical outcomes of surgical management for avulsion fractures involving its insertion when associated with periarticular knee fractures.Methods: Twenty-three patients (16 males and 7 females) with avulsion fractures of the ALL associated with periarticular knee fractures were fixed with a spider plate, cannulated screw, or suture anchor. Eight patients were diagnosed with distal femoral fracture, 10 with tibial plateau fracture, and 5 with tibial eminence avulsion fracture. All patients underwent X-rays at follow-up. Clinical and functional outcomes were assessed with the pivot-shift test, objective and subjective International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity scale.Results: The ALL was found and identified as a distinct ligamentous structure in all patients. Pre-Segond repair, patients had significantly more instability as determined by pivot-shift test than seen postoperatively (P < .0001). At final follow-up, the mean subjective IKDC score was 83.2±10.3. Fourteen patients were graded A, 6 were graded B, and 3 was graded C on the IKDC objective score. The mean Lysholm score was 85.4 ± 12.2. The mean Tegner score was 7.5 ± 1.2.Conclusion: This study confirmed that the ALL is a distinct structure in the anterolateral portion of the knee. The fixation for the avulsion fracture of the ALL associated with periarticular knee fractures can be an effective procedure without specific complications. Longer term and comparative follow-up studies are necessary to confirm the effects.

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“…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).…”

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confidence: 89%

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

Cavaignac¹,

Chiron²

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Articles on the anterolateral ligament have generated lots of discussion, but a worldwide consensus has been recently reached: the anterolateral ligament exists. Cadaver studies on a small number of subjects should not be used to draw conclusions as they do not replicate real life. We place our faith in clinical studies with a large number of patients as they capture the variability encountered in our practices. This is the true test of a scientific concept.

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

Cited by 14 publications

References 15 publications

Effect of Lateral Extra-articular Tenodesis on Anterior Cruciate Ligament Graft Incorporation

Effect of Lateral Extra-articular Tenodesis on Anterior Cruciate Ligament Graft Incorporation

Surgical Treatment for Avulsion Fractures of the Anterolateral Ligament Associated with Periarticular Fractures of the Knee

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

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