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The Stieda fracture revisited

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Abstract

Objective

This study aimed to evaluate injury patterns associated with Stieda avulsion fractures of the medial femoral condyle at the attachment of the proximal MCL.

Materials and methods

Knee radiographs and MRI scans of 11 patients with Stieda fractures were evaluated by two fellowship-trained MSK radiologists for fracture origin, integrity of the deep and superficial components of the MCL, medial retinacular structures, posterior oblique ligament, other ligamentous injuries, meniscal tears, and osteochondral injuries. The mechanism of injury and subsequent clinical management were recorded.

Results

Eight Stieda fractures only involved the meniscofemoral fibers of the deep MCL, two larger Stieda fractures related to both superficial and deep layers, and one fracture only involved the superficial layer. Posteromedial retinacular structures and posterior oblique ligament were injured in all cases. Eight had high-grade ACL injuries, but none had high-grade PCL nor FCL injuries. The proximal anterolateral ligament was injured in seven, including two with associated Segond fractures. Other injuries included posterolateral corner injuries in six, meniscal injuries in seven, and additional fractures in nine, most commonly ACL-associated impaction fractures in the lateral tibiofemoral compartment. None had high-grade chondral injury. None of the Stieda fractures were treated surgically, but four underwent subsequent ACL reconstruction.

Conclusion

Stieda fractures most commonly involved the deep fibers of the MCL and were accompanied by moderate-to-high-grade injury of other MCL components. There was a high association with other ligamentous injuries, particularly the posterior medial retinacular structures, posterior oblique ligament, and ACL, and many were associated with additional fractures.

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References

  1. Craft JA, Kurzweil PR. Physical examination and imaging of medial collateral ligament and posteromedial corner of the knee. Sports Med Arthrosc Rev. 2015;23(2):e1–6.

    Article  Google Scholar 

  2. Schein A, Matcuk G, Patel D, Gottsegen CJ, Hartshorn T, Forrester D, et al. Structure and function, injury, pathology, and treatment of the medial collateral ligament of the knee. Emerg Radiol. 2012;19(6):489–98.

    Article  Google Scholar 

  3. Pedersen RR. The medial and posteromedial ligamentous and capsular structures of the knee: review of anatomy and relevant imaging findings. Semin Musculoskelet Radiol. 2016;20(1):12–25.

    Article  Google Scholar 

  4. Trasolini NA, Lindsay A, Gipsman A, Rick Hatch GF. The biomechanics of multiligament knee injuries: from trauma to treatment. Clin Sports Med. 2019;38(2):215–34.

    Article  Google Scholar 

  5. LaPrade MD, Kennedy MI, Wijdicks CA, LaPrade RF. Anatomy and biomechanics of the medial side of the knee and their surgical implications. Sports Med Arthrosc Rev. 2015;23(2):63–70.

    Article  Google Scholar 

  6. Hayes CW, Brigido MK, Jamadar DA, Propeck T. Mechanism-based pattern approach to classification of complex injuries of the knee depicted at MR imaging. Radiographics. 2000;20 Spec No:S121-S134.

  7. Marchant MH, Tibor LM, Sekiya JK, Hardaker WT, Garrett WE, Taylor DC. Management of medial-sided knee injuries, part 1: medial collateral ligament. Am J Sports Med. 2011;39:1102–13.

    Article  Google Scholar 

  8. Schweitzer ME, Tran D, Deely DM, Hume EL. Medial collateral ligament injuries: evaluation of multiple signs, prevalence and location of associated bone bruises, and assessment with MR imaging. Radiology. 1995;194(3):825–9.

    Article  CAS  Google Scholar 

  9. de Maeseneer M, Shahabpour M, Pouders C. MRI spectrum of medial collateral ligament injuries and pitfalls in diagnosis. JBR-BTR. 2010;93:97–103.

    PubMed  Google Scholar 

  10. Robinson JR, Sanchez-Ballester J, Bull AMJ, De R, Thomas WM, Amis AA. The posteromedial corner revisited: an anatomical description of the passive restraining structures of the medial aspect of the human knee. J Bone Joint Surg (Br). 2004;86(5):674–81.

    Article  CAS  Google Scholar 

  11. Robinson JR, Bull AMJ, Thomas RRDW, Amis AA. The role of the medial collateral ligament and posteromedial capsule in controlling knee laxity. Am J Sports Med. 2006;34:1815–23.

    Article  Google Scholar 

  12. Taketomi S, Uchiyama E, Nakagawa T, Takeda H, Nakayama S, Fukai A, et al. Clinical features and injury patterns of medial collateral ligament tibial side avulsions: “wave sign” on magnetic resonance imaging is essential for diagnosis. Knee. 2014;21:1151–5.

    Article  Google Scholar 

  13. Kose O, Ozyurek S, Turan A, Guler F. Reverse Segond fracture and associated knee injuries: a case report and review of 13 published cases. Acta Orthopaedica et Traumatologica Turcica. Turkish Association of Orthopaedics and Traumatology. 2016;50:587–91.

    Google Scholar 

  14. Yazdi H, Gomrokchi AY, Aminizade S, Sohrabi S. Reverse Segond fracture without posterior cruciate ligament injury-a report of two cases and review of the literature. Journal of Orthopaedic Case Reports. 2019;9:90–2.

    PubMed  PubMed Central  Google Scholar 

  15. Stieda A. Uber eine typische verletzung am unteren femurende. Archiv für Klinische Chirurgie. 1908;85:815–26.

    Google Scholar 

  16. Fadl SA, Robinson JD. Core curriculum case illustration: [Stieda fracture (avulsion fracture of the medial femoral condyle)]. Emergency Radiology Springer New York LLC; 2018;25:103–105.

  17. Graham P. Avulsion fracture of the medial collateral ligament. Orthopaedic Nursing Lippincott Williams and Wilkins. 2017;36(2):164–6.

    Article  Google Scholar 

  18. Guo D, Yu H, Huang B, Gao X, Qin Y, Liu X. Avulsion of the femoral attachment of the medial collateral ligament in the setting of knee multi-ligament injury: a case report. Medicine (Baltimore). 2019;98(50):e18376.

    Article  Google Scholar 

  19. Calcei JG, Henry JK, Suryavanshi JR, Schachne JM, Fabricant PD. Operative treatment for a painful nonunion avulsion fracture of the femoral attachment of the medial collateral ligament in a teenager: a case report. JBJS Case Connect. 2019;9(2):e0281.

    Article  Google Scholar 

  20. Haddad S, Sallent A, Minguell J, Castellet E. Avulsion of the femoral attachment of the medial collateral ligament of the knee associated to complete tear of the posterior cruciate ligament: a case report. Surg J (N Y). 2017;3(1):e38–41.

    Article  Google Scholar 

  21. Albtoush OM, Horger M, Springer F, Fritz J. Avulsion fracture of the medial collateral ligament association with Segond fracture. Clin Imaging. 2019;53:32–4.

    Article  Google Scholar 

  22. Trikha SP, Acton D, Bell J. Avulsion of the common origin of the medial collateral and medial patello-femoral ligaments. Ann R Coll Surg Engl. 2004;86:442–4.

    Article  CAS  Google Scholar 

  23. McCarthy MM, Covey DC. An unusual case of an intra-articular osseous fragment associated with a medial collateral ligament femoral avulsion fracture in an adult. JBJS Case Connect. 2017;7(4):e92.

    Article  Google Scholar 

  24. Mellado JM, Ramos A, Salvadó E, Camins A, Calmet J, Saurí A. Avulsion fractures and chronic avulsion injuries of the knee: role of MR imaging. Eur Radiol. 2002;12(10):2463–73.

    Article  CAS  Google Scholar 

  25. Lundquist RB, Matcuk GR, Schein AJ, Skalski MR, White EA, Forrester DM, et al. Posteromedial corner of the knee: the neglected corner. Radiographics. Radiological Society of North America Inc.; 2015;35:1123–3117.

  26. Andrews K, Lu A, Mckean L, Ebraheim N. Review: medial collateral ligament injuries. J Orthop. 2017;14(4):550–4.

    Article  Google Scholar 

  27. Bintoudi A, Natsis K, Tsitouridis I. Anterior and posterior meniscofemoral ligaments: MRI evaluation. Anatomy Research International. 2012;2012:1–5.

    Article  Google Scholar 

  28. Park LS, Jacobson JA, Jamadar DA, Caoili E, Kalume-Brigido M, Wojtys E. Posterior horn lateral meniscal tears simulating meniscofemoral ligament attachment in the setting of ACL tear: MRI findings. Skelet Radiol. 2007;36:399–403.

    Article  Google Scholar 

  29. Elkin JL, Zamora E, Gallo RA. Combined anterior cruciate ligament and medial collateral ligament knee injuries: anatomy, diagnosis, management recommendations, and return to sport. Curr Rev Musculoskelet Med. 2019;12(2):239–44.

    Article  Google Scholar 

  30. Westermann RW, Spindler KP, Huston LJ, Amendola A, Andrish JT, Brophy RH, et al. Outcomes of grade III medial collateral ligament injuries treated concurrently with anterior cruciate ligament reconstruction: a multicenter study. Arthroscopy - Journal of Arthroscopic and Related Surgery. 2019;35:1466–72.

    Article  Google Scholar 

  31. Marchant MH, Tibor LM, Sekiya JK, Hardaker WT, Garrett WE, Taylor DC. Management of medial-sided knee injuries, part 1: medial collateral ligament. Am J Sports Med. 2011;39:1102–13.

    Article  Google Scholar 

  32. Alaia EF, Rosenberg ZS, Alaia MJ. Stener-like lesions of the superficial medial collateral ligament of the knee: MRI features. American Journal of Roentgenology American Roentgen Ray Society. 2019;213:W272–6.

    Article  Google Scholar 

  33. Boutin RD, Fritz RC, Walker REA, Pathria MN, Marder RA, Yao L. Tears in the distal superficial medial collateral ligament: the wave sign and other associated MRI findings. Skeletal Radiology Springer. 2020;49:747–56.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Stanford University Medical Center, Grant Building S062A, 300 Pasteur Drive, Stanford, CA, 94305, USA

    Kathryn J. Stevens & Amelie M. Lutz

  2. Department of Diagnostic and Interventional Radiology, University of Jordan, Queen Rania Street, Amman, 11942, Jordan

    Omar M. Albtoush

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  1. Kathryn J. Stevens
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Correspondence to Kathryn J. Stevens.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Stevens, K.J., Albtoush, O.M. & Lutz, A.M. The Stieda fracture revisited. Skeletal Radiol 50, 945–953 (2021). https://doi.org/10.1007/s00256-020-03645-z

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  • DOI: https://doi.org/10.1007/s00256-020-03645-z

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