2015 ISAKOS Biennial Congress ePoster #1305

The Incidence of Segond Fracture in Patients With ACL Rupture

Rhodri Gwyn, MBBCH, MRCS(Ed), Swansea, Wales UNITED KINGDOM
Ben A. Hickey, MBBCH, MRCS(Ed), Cardiff, Wales UNITED KINGDOM
Angus Robertson, BSc, FRCSEd(Tr&Orth) FFSEM(UK), Abergavenny, Monmouthshire UNITED KINGDOM
University Hospital Of Wales, Cardiff, Wales, UNITED KINGDOM

FDA Status Not Applicable

Summary: Segond fractures are rare in patients with an ACL rupture. Oedema at the insertion site of the Anteriolateral Ligament may represent a sprain but Pivot shift rates are the same as without oedema.

Abstract:

Background.
The presence of a Segond Fracture is thought to be pathognomonic for Anterior Cruciate Ligament (ACL) rupture (1,2,3). Recently the anatomy of the anterolateral ligament (ALL) of the knee has been further defined (4) and it is hypothesized that the ALL acts as a stabilizer of internal rotation (1,2,3,4). Our primary aim was to identify the incidence of Segond fractures in patients with ACL rupture. Our secondary aim was to determine its clinical significance.

Methods.
186 patients from a single surgeon series of primary ACl reconstructions were identified. The MRI and plain radiographs were reviewed for the presence of Segond fracture and oedema at the ALL insertion site along with the operative note documenting the findings of clinical examination under anaesthesia.

Results.
149 patients were male, 37 female. The average age at operation was 28. 158 patients underwent primary single bundle arthroscopic ACL reconstruction. 28 patients underwent primary double bundle arthroscopic ACL reconstruction.
160 patients had MRI and plain radiographs available, 25 patients were excluded due to imaging being unavailable. A Segond fracture was visible on the plain radiographs in four patients (2.5%) and was found in a further three (1.9%) patients on MRI. Oedema was found on MRI imaging posterior to Gerdys’ tubercle in the site described as the insertion for the ALL in 33 (21%) patients. This included all the patients with identified Segond fractures.
On examination under anaesthesia pivot shift was elicited in 124 (77%) of patients. In the group with Segond fractures five (72%) had pivot-shift, the difference between groups was not statistically significant (p=0.65). In the group with oedema at the insertion of ALL pivot-shift was elicited in 22 (84%) patients, this value was higher but not statistically significant (p=0.6).

Conclusions.
Segond fractures are rare with an incidence of 2.5% on plain radiography. Oedema of the insertion point of the ALL may represent a sprain of the ALL. Pivot shift instability rates were similar in all patient groups. The importance of segond fracture and oedema on mri in antrolateral instability and therefore the need to repair the ALL is questioned.