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Introducción El complejo anterolateral de la rodilla es un estabilizador secundario de la rotación tibial interna, su inserción distal esta localizada en el aspecto anterolateral de la tibia proximal y su avulsión es conocida como fractura de Segond, fue descrita hace mas de un siglo por el cirujano francés que le dio su nombre. Es frecuente la asociación de la lesión del ligamento cruzado anterior (LCA) con este complejo, tanto que en la actualidad se considera la fractura de Segond como un signo patognomónico de ruptura del cruzado anterior. Dada la importancia de brindar estabilidad rotacional desde la periferia de la articulación y las propiedades cada vez mas reconocidas de las estructuras anterolaterales, este artículo reporta un caso de fijación directa de la fractura de Segond, en el cual se buscó restituir la anatomía original de la rodilla. Métodos Revisión de la literatura relevante y reporte retrospectivo del caso de un paciente con lesión de LCA y fractura de Segond que fue llevado a reconstrucción de LCA con autoinjerto de HTH y reducción directa y fijación con sutura de anclaje de fractura de Segond por una incisión mínima, con un seguimiento clínico de 4 años. Se aplicaron escalas de valoración subjetiva previo al procedimiento y en el seguimiento postoperatorio. Resultados La inestabilidad anterior y anterolateral posterior al manejo quirúrgico presentó mejoría clínica pasando de tener Lachman IIB a negativo, y Pivot shift grado II a negativo. Las escalas de valoración subjetivas de Lysholm e IKDC mejoraron notablemente de resultados regulares previo al procedimiento a excelentes en el postoperatorio. No presentó complicaciones durante el procedimiento ni requirió reintervenciones. Discusión Aunque la fractura de Segond está descrita desde hace más de un siglo, y su asociación con lesiones de ligamento cruzado anterior se documentó hace mas de 20 años, aun no hay consenso en el manejo de esta fractura. Desde el punto de vista biomecánico, una estructura localizada en el centro de la rodilla como el LCA, de manera aislada, sería insuficiente para controlar la rotación tibial en relación al fémur. Por lo tanto, sería lógico pensar que una estructura localizada lejos del centro de rotación de la rodilla pueda ser más efectiva en controlar la rotación ya que ejerce un mayor control del torque rotacional. Reportamos resultados funcionales satisfactorios y estabilidad postoperatoria adecuada a 4 años de seguimiento, posterior a la fijación de la fractura de Segond asociada a reconstrucción de LCA; consideramos que puede ser una medida exitosa y segura para el manejo de la inestabilidad anterolateral de la rodilla.
Introduction The anterolateral complex of the knee is a secondary stabiliser of the internal tibial rotation. Its distal insertion is located in the anterolateral aspect of the proximal tibia, and its avulsion is known as Segond fracture. This was described more than a century ago by the French surgeon who gave it his name. The combination of anterior cruciate ligament injury (ACL) with the anterolateral complex is so common in as much that Segond fracture is currently considered as a pathognomonic sign of rupture of the anterior cruciate. Given the importance of providing rotational stability from the periphery of the joint and the increasingly recognised properties of the anterolateral structures, this article reports a case of direct fixation of the Segond fracture, in which it was sought to restore the original anatomy of the knee. Methods Review of relevant literature and retrospective case report of a patient with ACL injury and Segond fracture who underwent ACL reconstruction with a host-to-host (HTH) autograft and direct reduction and fixation with Segond fracture anchor suture through a minimal incision. There was a clinical follow-up of 4 years. Subjective assessment scales were applied prior to the procedure and in the postoperative follow-up. Results Anterior and anterolateral instability after surgical management showed a clinical improvement, going from having Lachman IIB to negative, and from Pivot shift grade II to negative. The subjective rating scales of Lysholm and International Knee Documentation Committee (IKDC) improved markedly from regular results prior to the procedure to excellent in the postoperative period. There were no complications during the procedure and no reoperations were required Discussion Although the Segond fracture has been described for more than a century, and its association with anterior cruciate ligament injuries was documented more than 20 years ago, there is still no consensus on the management of this fracture. From the biomechanical point of view, a structure located in the centre of the knee like the ACL, in isolation, would be insufficient to control the tibial rotation in relation to the femur. Therefore, it would be logical to think that a structure located far from the centre of rotation of the knee can be more effective in controlling rotation, since it exerts a greater control of rotational torque. Satisfactory functional results are reported, together with an adequate postoperative stability at 4 years of follow-up, after the fixation of the Segond fracture associated with ACL reconstruction. It is considered that this can be a successful and safe measure for the management of anterolateral instability of the knee.
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Humans , Tibial Fractures , Anterior Cruciate Ligament Reconstruction , Joint Instability , KneeABSTRACT
<p><b>OBJECTIVE</b>To investigate the characteristics and clinical treatment of avulsion fracture of the lateral edge of tibial plateau(segond fracture) in knee joint injuries.</p><p><b>METHODS</b>From January 2011 and December 2015, 29 patients with Segond fracture were treated with minimally invasive arthroscopy technology in intra-articular injuries combined with double anchor nail fixation in avulsion fracture of the lateral edge of tibial plateau, including 17 males and 12 females with an average age of 41 years old ranging from 27 to 62 years old. Among them, there were 20 cases of anterior cruciate ligament rupture (ACL rupture) involving the anterior cruciate ligament tibial eminence avulsion fracture included, 3 cases of posterior cruciate ligament rupture (PCL rupture), 1 case of ACL rupture combined with PCL rupture, 3 cases of medial collateral ligament tear, and 2 cases combined fractures of tibial plateau (1 case of the medial platform fractures and 1 cases of lateral fracture). All the patients were confirmed by X-rays, CT and MRI. The procedures were performed at 5 to 14 days after the injury(means 7 days). Lysholm scores were used to assess the knee function before and after the operation.</p><p><b>RESULTS</b>The operation time was 40 to 125 minutes (means 85 minutes), the intraoperative blood loss was 10 to 30 ml (means 15 ml). All paients were followed up for 12 to 18 months(means 14 months). The Lysholm scores were significantly improved from preoperative 52.0±4.2 to 91.9±1.4(=-49.24,<0.05). The results of drawer test, Lachman test and lateral stress test were negative in all 29 cases, all the fractures of 29 patients were bony union.</p><p><b>CONCLUSIONS</b>The avulsion fracture of the lateral tibial plateau suggests that there are knee joint static and stable structures(joint ligament, joint capsule, meniscus, et al) and even intra articular fractures. Therefore, besides conventional imaging examinations, arthroscopic exploration was also necessary to avoid misdiagnose and provide comprehensive assessments and treatment. This can create favorable conditions for the knee joint function restore maximum.</p>
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Objective To observe the anatomical and histological features of anterolateral ligament (ALL)in the knee of Chinese adults,so as to identify the existence of ALL and provide an anatomical foundation for clinical reconstruction.Methods Ten adult knee specimens were randomly selected to be dissected,and the femoral,tibial and meniscus attachment points of the ALL were observed.The length,width and thickness were measured using the vernier caliper after the dissection.Three specimens were subjected to histological staining in the end.Results (1)ALL originated from the lateral femoral condyle—the same point of the lateral collateral ligament femoral side or the distal-anterior side,with its body divided into two branches,located in the tibia and the lateral meniscus respectively.The starting point of tibial side ALL was located at the mid-point of Gerdy's tubercle to fibula head,below tibial cartilage edge,with the meniscus point located in the lateral meniscus anterior horn and body junction area.(2) The average length of ALL is 38.89 ± 4.67 mm.The width in the femur,tibial attachment point was fan-shaped spread connected with sclerotin,being the narrowest at the joint line.The width at the femur,tibial attachment point and the joint line was 8.49 ± 1.36 mm,8.15 ± 1.38 mm and 6.49 ± 1.09 mm respectively,with the thickness of 1.33 ± 0.38 mm.The distance from tibia attachment points to the Gerdy's tubercle,fibular head and tibia cartilage margin was 22.59 ± 3.04 mm,21.15 ± 2.78 mm and 5.76 ± 0.57 mm respectively.(3) HE staining showed that ALL was dense connective tissue consisting of parallel arranged collagen fibers,while S-100 staining indicated that ALL contained sensory motor nerve fibers.Conclusion ALL is independent of the joint capsule and originates from the femoral lateral condyle.Its body is divided into two branches,located in the tibia and the lateral meniscus respectively.
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PURPOSE: Patients with Segond fracture have a high probability of anterior cruciate ligament and meniscal injury. The purpose of this study is to evaluate the site and shape of fragment of Segond fracture on plain radiograph and to analyze associated intraarticular injuries of knee joint on Magnetic Resonance(MR) imaging. MATERIALS AND METHODS: From July. 1994 to June 2002, 10 Segond fractures were reviewed retrospectively on plain radiograph and MR imaging. We confirmed by arthroscopic findings that ligamentous injuries and meniscal injuries were associated in all of the 10 cases. RESULTS: The radiographic findings of Segond fractures were as follows: the elliplical shape was 8 case, the average size 7.2 mm x 2.5 mm (length x width), the location average 4.3mm below tibial articular surface and the displacement average 2.0 mm from original site. Of the 10 patients, 9 (90%) had anterior cruciate ligament (ACL), 2 posterior cruciate ligament, 2 lateral collateral ligament and 4 medial collateral ligament injury. Meniscal injury was also diagnosed in 6. CONCLUSION: In plain radiograph of patients with acute traumatic knee injury, the caution is needed to examine Segond fracture. MR imaging is an useful study because anterior cruciating ligament disruption is often associated with Segond fracure.