Summary

For ACL reconstruction, both with and without Segond’s fracture had good clinical and radiological outcomes without significant differences between two groups.

Abstract

Background

Several authors have described the importance of the lateral capsular ligament or anterolateral ligament as a restraint against anterolateral rotational instability of the knee. Also the structure described in those earlier studies was claimed to be responsible for the Segond fracture, an avulsion of the lateral rim of the tibial plateau. However, the effects of Segond fracture on preoperative and postoperative instability is still not known. The purpose of this study was to compare clinical and radiographic outcomes of patients received ACL reconstruction with or without Segond’s fracture associated. We also compared the stability before ACL reconstruction in patients with or without Segond’s fracture.

Materials And Methods

From January 2010 to December 2014, 100 patients who had ACL injury (more than 6 weeks after injury) with or without Segond’s fracture were enrolled in this study. We excluded associated ligament injury other than ACL to need surgery. They were followed up more than 1 year after ACL reconstruction using hamstring autograft or tibialis allograft. While 32 patients had Segond’s fractures, 68 patients did not have Segond’s fractures. Before and after the reconstruction, we compared the stabilities based on Lachman and pivot-shift test between two groups. The clinical outcomes including Lysholm knee, Tegner activity score and IKDC scores were evaluated in two groups. Radiological stability outcomes evaluated difference between anterior drawer in affected side and unaffected side by Telos? stress radiograph.

Results

Lysholm knee score and Tegner activity score improved to 93.3 and 5.3 in Segond’s fracture group and 94.3 and 5.2 in no Segond’s fracture groups, but there was no difference between the two groups. On Lachman and pivot-shift test improved to grade 0 or 1 in both group after reconstruction. However, there were no differences in before and after reconstruction in each parameter. At Telos? stress radiograph, difference between anterior drawer in affected side and unaffected side showed improvement in both group; 3.2mm in Segond’s fracture group and 2.5mm in no Segond’s fracture groups, but there was no difference after reconstruction as well as before reconstruction between the two groups.

Conclusions

For ACL reconstruction, both with and without Segond’s fracture had good clinical and radiological outcomes without significant differences between two groups. Moreover, the instability was similar before ACL reconstruction regardless of Segond’s fracture.

Key words : ACL reconstruction, Segond’s fracture, Hamstring autograft, Tibialis allograft.