Segond fracture: an MR evaluation of 146 patients with emphasis on the avulsed bone fragment and what attaches to it
- 932 Downloads
To re-evaluate the Segond fragment emphasizing those structures that attach to the fragment in patients with reported acute/subacute anterior cruciate ligament (ACL) injuries, and to clarify the nomenclature used to describe these structures.
Materials and methods
A search of databases of knee MR examinations over 4.5 years with reported ACL tears yielded 19,726 studies. Using strict exclusion criteria, a total of 146 MR studies with acute/subacute ACL tears were re-assessed with respect to the Segond fragment's size, shape, orientation, location, displacement, attaching soft tissue structures, and associated osseous and/or soft tissue injuries.
Segond fractures were present in 1.25 % of reported acute/subacute ACL tears. The fragment measured 11.9 × 7.3 × 3.27 mm, being thin, ovoid, vertically oriented, situated anterolaterally along the proximal tibial epiphysis, posterior to Gerdy's tubercle and inferior to the lateral tibial plateau, and displaced up to 6 mm laterally. The attached structures were the meniscotibial component of the mid-third lateral capsular ligament (mt-MTLCL) in 58.9 %, both the mt-MTLCL and the posterior fibers of the ITB (pf-ITB) in 35.6 %, and the pf-ITB in 5.48 % of cases. In no case was there an additional attaching structure that did not meet criteria for the mt-MTLCL or the pf-ITB.
The mt-MTLCL most commonly attaches to the Segond fragment, but the pf-ITB can also attach to this fragment. In no case was there an additional attaching structure that did not meet criteria for the mt-MTLCL or the pf-ITB.
KeywordsSegond fracture Meniscotibial component of the mid-third lateral capsular ligament Posterior fibers of the iliotibial band Anterior cruciate ligament tear MRI
Thanks go to Dr Michael Stadnick with Radsource for providing the search engine and some of the cases for this study.
Compliance with ethical standards
Institutional review board statement
This study complied with HIPAA guidelines and institutional review board approval, along with an exemption status for informed consent.
Conflicts of interest
The authors declare that they have no conflicts of interest.
- 1.Segond PP. Recherches cliniques et expérimentales sur les épanchements sanguins du genou par entorse. Prog Med. 1879;7:297–9.Google Scholar
- 10.Irvine G, Dias J, Finlay D. Segond fractures of the lateral tibial condyle: brief report. J Bone Jt Surg. 1987;69(4):613–4.Google Scholar
- 12.Last R. Some anatomical details of the knee joint. J Bone Jt Surg. 1948;30B(4):683–8.Google Scholar
- 21.Coquart B, Le Corroller T, Laurent PE, Ollivier M, Pradel V, Champsaur P, et al. Anterolateral ligament of the knee: myth or reality? Surg Radiol Anat. 2016; doi: 10.1007/s00276-016-1657-2.
- 22.Van Dyck P, Clockaerts S, Vanhoenacker FM, Lambrecht V, Wouters K, de Smet E, et al. Anterolateral ligament abnormalities in patients with acute anterior cruciate ligament rupture are associated with lateral meniscal and osseous injuries. Eur Radiol. 2016; doi: 10.1007/s00330-015-4171-8.
- 36.Helito C, Demange M, Helito P, Costa H, Bonadio M, Pecora J, et al. Evaluation of the anterolateral ligament of the knee by means of magnetic resonance examination. Rev Bras Ortop (English Ed). 2015;50(2):214–9.Google Scholar
- 45.Helito CP, Bonadio MB, Rozas JS, Wey JMP, Pereira CAM, Cardoso TP, et al. Biomechanical study of strength and stiffness of the knee anterolateral ligament. BMC Musculoskelet Disord. 2016;17(193):1–7.Google Scholar
- 48.Castillo M. Doctors discover new knee ligament that may be crucial for ACL injuries. CBS News [Internet]. Available from: http://www.cbsnews.com/news/doctors-discover-new-knee-ligament-that-may-be-crucial-for-acl-injuries/. Accessed 12 December 2015.
- 50.Main D. New ligament found in human knee. [Internet]. Available from: http://www.livescience.com/40981-new-ligament-found-in-human-knee.html.. Accessed 12 December 2015.
- 51.Mundasad S. New ligament discovered in knee, Belgian surgeons say. BBC News [Internet]. Available from: http://www.bbc.com/news/health-24826323.. Accessed 23 November 2015.
- 52.KU Leuven. Surgeons describe new ligament in the human knee. ScienceDaily [Internet]. Available from: http://www.sciencedaily.com/releases/2013/11/131105081352.htm.. Accessed 12 December 2015.
- 53.Reynolds G. Doctors identify a new knee ligament. The New York Times [Internet]. Available from: http://well.blogs.nytimes.com/2013/11/13/a-surprising-discovery-a-new-knee-ligament/?_r=0.. Accessed 23 November 2015.
- 55.Rasmussen MT, Nitri M, Williams BT, Moulton SG, Cruz RS, Dornan GJ, et al. An in vitro robotic assessment of the anterolateral ligament. I. Secondary role of the anterolateral ligament in the setting of an anterior cruciate ligament injury. Am J Sports Med. 2016;44(3):585–92.PubMedCrossRefGoogle Scholar