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Garra S, Moore MR, Li ZI, Eskenazi J, Jazrawi T, Bi AS, Campbell KA, Alaia MJ, Strauss EJ. Segond fracture: an indicator for increased risk of lateral meniscus injury in patients with acute anterior cruciate ligament ruptures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1883-1891. [PMID: 38448565 DOI: 10.1007/s00590-024-03857-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/08/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE The purpose of this study was to investigate the incidence and anatomic distribution of meniscus injury in patients who have sustained acute ACL injuries with and without concomitant Segond fracture. We hypothesized that patients who have sustained a torn ACL with a concomitant Segond fracture would have a higher incidence of lateral meniscal injuries than patients with an isolated ACL injury. METHODS Patients who underwent ACL reconstruction from 2012 to 2022 were retrospectively reviewed. Segond fractures were identified on knee radiographs. Inclusion criteria were age 18-40, injury during sports activity, and reconstruction within 90 days of injury. Sports activity, anatomic location of meniscus injury, and meniscus treatment were documented. Multivariable regression was used to identify predictors of meniscus injury/treatment. RESULTS There were 25 of 603 (4.1%) patients who had an ACL tear with concomitant Segond fracture. The incidence of lateral meniscus injury in the Segond group (72%) was significantly higher than in the non-Segond cohort (49%; p = 0.024). A significantly smaller proportion of medial meniscus injuries among patients with Segond fractures were repaired (23.1%) compared to the non-Segond group (54.2%; p = 0.043). Multivariate analysis found patients with Segond fractures to have increased odds of lateral meniscus injury (OR 2.68; [1.09, 6.60], p = 0.032) and were less likely to have medial meniscus injuries repaired (OR 0.35; [0.15, 0.81], p = 0.014). Additionally, males had increased odds of lateral meniscus injury (OR 1.54; [1.08 - 2.91], p = 0.017), which were more likely to require repair (OR 1.48; [1.02, 2.14], p = 0.038). CONCLUSIONS Among acute ACL injuries, the incidence of lateral meniscus injury is greater among patients with Segond fractures. Patients with Segond fracture were less likely to undergo repair of medial meniscal injuries.
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Affiliation(s)
- Sharif Garra
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA.
- Division of Orthopedic Surgery, Tel-Hashomer "Sheba" Medical Center, Tel-Aviv University, Ramat Gan, Israel.
| | - Michael R Moore
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Zachary I Li
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Jordan Eskenazi
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Taylor Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Andrew S Bi
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Kirk A Campbell
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Michael J Alaia
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Eric J Strauss
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
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Garra S, Li ZI, Eskenazi J, Jazrawi T, Rao N, Campbell KA, Alaia MJ, Strauss EJ, Jazrawi LM. Patients With Segond Fracture Demonstrate Similar Rates of Return to Sport and Psychological Readiness After Anterior Cruciate Ligament Reconstruction: A Matched Cohort Study at Minimum 2-Year Follow-Up. Arthroscopy 2024; 40:1247-1255. [PMID: 37716633 DOI: 10.1016/j.arthro.2023.08.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE To compare clinical outcomes, rate of return to sports, and psychological readiness among patients undergoing anterior cruciate ligament reconstruction (ACLR) with and without concomitant Segond fracture. METHODS We retrospectively identified patients who underwent primary ACLR from January 2012 to December 2020 with minimum 2-year follow-up. Exclusion criteria were additional ligamentous injury, age <16 years, or a concomitant lateral augmentation procedure. Preoperative knee radiographs were reviewed to identify Segond fractures. Identified patients were matched 1:2 to controls by age/sex/body mass index/graft type. Charts were reviewed for pre- and postoperative knee stability. Surveys administered included preinjury sport participation and return status, Lysholm score, Tegner activity scale, and ACL-Return to Sport Index (ACL-RSI), a metric of psychological sport readiness. Multivariable logistic regression was conducted to identify predictors of return to sport. RESULTS There were 120 patients who were included in the final analysis (40 Segond, 80 controls) at a mean follow-up of 5.7 ± 2.4 years. A total of 52.5% of patients received bone-patellar tendon-bone autograft. The overall rate of return to sport was 79.5% in the Segond group compared with an 83.8% rate of return in the control group (P = .569). In total, 48.7% of the Segond group and 56.8% of the control group returned to their preinjury level of sport (P = .415). Lysholm (89.6 ± 10.3 vs 85.4 ± 16.7, P = .296), Tegner (5.7 ± 1.8 vs 6.1 ± 2.2, P = .723), and ACL-RSI (62.2 ± 25.4 vs 56.6 ± 25.4, P = .578) scores were similar between Segond and control groups. There was a single graft failure in the Segond group 5 years' postoperatively. Increasing ACL-RSI score was significantly predictive of return to sport (P < .001). CONCLUSIONS Patients who had an ACL tear and a concomitant Segond fracture who underwent isolated ACLR without lateral augmentation procedures had similar clinical outcomes and rates of return sport compared with a matched isolated ACLR control group at minimum 2-year follow-up. There was no significant difference in psychological readiness between groups as measured by the ACL-RSI. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Sharif Garra
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A.; Division of Orthopedic Surgery, Tel-Hashomer "Sheba" Medical Center, Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel.
| | - Zachary I Li
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Jordan Eskenazi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Taylor Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Naina Rao
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Kirk A Campbell
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Michael J Alaia
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Eric J Strauss
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
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Ng MK, Vasireddi N, Emara AK, Lam A, Voyvodic L, Rodriguez AN, Pan X, Razi AE, Erez O. Anterolateral knee complex considerations in contemporary anterior cruciate ligament reconstruction and total knee arthroplasty: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:319-330. [PMID: 37490068 DOI: 10.1007/s00590-023-03647-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023]
Abstract
The anterolateral ligament (ALL) was first described in 1879 in the context of Segond fractures, which correlate with a 75-100% chance of an anterior cruciate ligament (ACL) tear or a 66-75% chance of a meniscal tear. The purpose of this paper is to provide an updated comprehensive review on the anterolateral ligament complex of the knee focusing on the: (1) anatomy of the ALL/ALC; (2) associated biomechanics/function; and (3) important surgical considerations in contemporary anterior cruciate ligament (ACL) reconstruction and total knee arthroplasty (TKA). A systematic review of studies on ALL was conducted on Pubmed/MEDLINE and Cochrane databases (May 7th, 2020 to February 1st, 2022), with 20 studies meeting inclusion/exclusion criteria. Studies meeting inclusion criteria were anatomical/biomechanical studies assessing ALL function, cadaveric and computer simulations, and comparative studies on surgical outcomes of ALLR (concomitant with ACL reconstruction). Eight studies were included and graded by MINOR and Newcastle-Ottawa scale to identify potential biases. The anatomy of the ALL is part of the anterolateral ligament complex (ALC), which includes the superficial/deep iliotibial band (including the Kaplan fiber system), iliopatellar band, ALL, and anterolateral capsule. Multiple biomechanical studies have characterized the ALC as a secondary passive stabilizer in resisting tibial internal rotation. Given the role of the ALC in resisting internal tibial rotation, lateral extra-articular procedures including ALL augmentation may be considered for chronic ACL tears, ACL revisions, and a high-grade pivot shift test. In the context of TKA, in the event of injury to the ALC, a more constrained implant or soft-tissue reconstruction may be necessary to restore appropriate knee stability.
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Affiliation(s)
- Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA
| | - Nikhil Vasireddi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Aaron Lam
- Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA
| | - Lucas Voyvodic
- Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA
| | - Ariel N Rodriguez
- Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA.
| | - Xuankang Pan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Afshin E Razi
- Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA
| | - Orry Erez
- Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA
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Suzuki N, Watanabe A, Ninomiya T, Nakajima H, Horii M, Watanabe S, Shiko Y, Sasho T. Lateral meniscal injury without medial meniscal injury indicates the existence of the Segond fracture in ACL-deficient knees. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 35:59-64. [PMID: 38236496 PMCID: PMC10792093 DOI: 10.1016/j.asmart.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/13/2023] [Accepted: 11/27/2023] [Indexed: 01/19/2024] Open
Abstract
Background/Objective The purpose of this study was to find factors indicating the occurrence of the Segond fracture, a specific type of anterolateral ligament injury. Methods From January 2015 to December 2017, we retrospectively reviewed the medical records of patients diagnosed with acute anterior cruciate ligament (ACL) injury who underwent reconstruction within 90 days of injury. Diagnosis of the Segond fracture was determined either by magnetic resonance imaging or plain radiographs. Factors examined were: age at surgery, sex, body mass index (kg/m2), status of menisci, and activities led to ACL injury. After univariate screening, multivariate logistic regression analyses were performed. Patients were divided into four groups based on the presence of lateral meniscal (LM) and/or medial meniscal (MM) injuries and compared with respect to the occurrence of Segond fractures. Results A total of 375 patients were included (163 males, 212 females), with mean age 25.8 years old. Among them, 22 of 375 (5.9 %) had a Segond fracture. We identified injured lateral menisci (adjusted odds ratio (aOR), 3.029; 95 % Confidence Interval (CI), 1.206-7.609; P = 0.018), intact medial menisci (aOR, 0.229; 95 % CI, 0.065-0.810; P = 0.022), and higher body mass index (aOR, 1.102; 95 % CI, 1.008-1.205; P = 0.034) as factors indicative of the occurrence of Segond fracture. LM injury without MM injury suggested the existence of a Segond fracture. Conclusion LM injury without a MM injury indicated the occurrence of a Segond fracture. Higher body mass index also increased the risk for Segond fracture occurrence.
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Affiliation(s)
- Nobutada Suzuki
- Department of Radiology, Eastern Chiba Medical Center, 3-6-1 Okayamadai, Togane, Chiba, 283-8686, Japan
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Atsuya Watanabe
- Department of Orthopedic Surgery, Eastern Chiba Medical Center, 3-6-1 Okayamadai, Togane, Chiba, 283-8686, Japan
| | - Taishi Ninomiya
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
- Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, 1-833 Hasamacho, Funabashi, Chiba, 274-0822, Japan
| | - Hirofumi Nakajima
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
- Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, 1-833 Hasamacho, Funabashi, Chiba, 274-0822, Japan
| | - Manato Horii
- Department of Orthopedic Surgery, Eastern Chiba Medical Center, 3-6-1 Okayamadai, Togane, Chiba, 283-8686, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Shotaro Watanabe
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-0856, Japan
| | - Takahisa Sasho
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
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Phua SKA, Lim JY, Li T, Ho SWL. The segond fracture: A narrative review of the anatomy, biomechanics and clinical implications. J Clin Orthop Trauma 2023; 38:102127. [PMID: 36860993 PMCID: PMC9969264 DOI: 10.1016/j.jcot.2023.102127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 02/05/2023] [Accepted: 02/11/2023] [Indexed: 03/03/2023] Open
Abstract
The Segond fracture is commonly regarded as pathognomonic for significant intra-articular pathology such as an anterior cruciate ligament (ACL) tear. There is worsened rotatory instability in patients with concomitant ACL tear and Segond fracture. Current evidence does not suggest that a concomitant and unrepaired Segond fracture leads to worst clinical outcomes after ACL reconstruction. However, there remains a lack of consensus on several aspects of the Segond fracture such as its exact anatomical attachments, ideal imaging modality for detection and indication for surgical treatment. There is currently no comparative study evaluating the outcomes of combined ACL reconstruction and Segond fracture fixation. More research is necessary to deepen our understanding and establish consensus on the role of surgical intervention.
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Affiliation(s)
| | - Jia Ying Lim
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Tianpei Li
- Department of Radiation Oncology, National Cancer Centre, Singapore
| | - Sean Wei Loong Ho
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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Haase L, Nelson G, Raji Y, Brown M, Karns M, Voos J, Calcei JG. Patients With Anterior Cruciate Ligament Rupture and Ipsilateral Segond Fractures Have High Rates of Concurrent Knee Pathology. Arthrosc Sports Med Rehabil 2023; 5:e375-e379. [PMID: 37101873 PMCID: PMC10123414 DOI: 10.1016/j.asmr.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 01/04/2023] [Indexed: 02/13/2023] Open
Abstract
Purpose The purpose of this study was to determine the rates of concomitant knee pathology in patients with ACL injuries and Segond fractures. Methods A retrospective study is undertaken with patients identified via query of CPT codes for ACL reconstruction from 2014 to 2020. All patients with preoperative radiographs were reviewed for the presence of Segond fractures. Operative reports were analyzed for the presence of concurrent pathology, including meniscus, cartilage, and other ligamentous injuries at the time of arthroscopic ACL reconstruction. Results A total of 1,058 patients were included in the study. Segond fractures were identified in 50 (4.7%) patients. Ipsilateral concomitant knee pathology was identified in 84% of Segond patients. Thirty-eight (76%) patients had meniscal pathology with a total 49 meniscal injuries, of which 43 were treated operatively. Multiligamentous injuries were present in 16 patients (32%), with 8 patients undergoing further ligament repair/reconstruction at the time of surgery. Chondral injuries were identified in 13 patients (26%). Conclusions A high prevalence of concomitant meniscal, chondral, and ligamentous injuries was found in patients with Segond fractures. These additional injuries may require further operative management and may place patients at increased risk for future instability or degenerative changes. Patients with Segond fractures should be counseled preoperatively on the nature of their injuries and risk of associated pathologies. Level of Evidence Level IV, prognostic case series.
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Affiliation(s)
- Lucas Haase
- Address correspondence to Lucas Haase, M.D., University Hospitals of Cleveland, 11100 Euclid Ave., Cleveland, OH, 44106, U.S.A.
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Anterior cruciate ligament rupture and associated Segond fracture: Incidence and effect on associated ligamentous and meniscal injuries. Asia Pac J Sports Med Arthrosc Rehabil Technol 2022; 30:36-40. [PMID: 36312215 PMCID: PMC9578960 DOI: 10.1016/j.asmart.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 07/25/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction The Segond fracture is an avulsion fracture of the lateral tibial plateau and is widely considered to be pathognomonic of anterior cruciate ligament (ACL) rupture. In addition to ACL rupture, Segond fractures have also been noted to be associated with significant intra-articular pathology such as meniscal injuries as well as extra-articular pathology such as collateral ligament injuries. This is likely due to the fact that the presence of a Segond fracture may represent increased rotatory instability. Whilst several studies have demonstrated the association of a Segond fracture with significant intra-articular pathology, there is a paucity of literature assessing if the combination of an ACL rupture and Segond fracture gives rise to higher rates of concomitant ligamentous and meniscal injuries. The primary objective of this study is to determine if patients with ACL ruptures associated with Segond fractures have higher rates of concomitant ligamentous and meniscal injury, when compared to patients with ACL ruptures without a Segond fracture. Methods A retrospective review of all patients who underwent ACL reconstruction in a single institution between 2014 to 2018 was conducted. A review of the patients’ demographics, operative notes, and radiographs was performed. X-rays and MRI scans were double-read by a board-certified radiologist and Orthopaedic surgeon. Results A total of 414 subjects were included. The incidence of Segond fracture was 2.4%. The mean age was 24.7±7.4 (range 16 to 60) years and 26.7±7.6 (range 16 to 38) years in patients with and without Segond fractures respectively. 89.9% of patients suffered a non-contact mechanism of injury, with sports injuries being most common (79.5%). There was a significantly higher rate of isolated lateral meniscus tears in patients with Segond fractures compared to those without (50% v.s. 20.8%) based on pre-operative MRI. (p<0.05) There were no other significant differences in associated ligamentous injuries. Conclusion The incidence of Segond fracture associated with ACL rupture is 2.4%. There is a significantly higher risk of a concomitant isolated lateral meniscus tear in ACL ruptures associated with a Segond fracture. There is no significantly higher risk of concomitant ligamentous injuries in ACL ruptures associated with a Segond fracture.
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