Segond Fractures Involve the Anterolateral Knee Capsule But Not the Iliotibial Band.

PURPOSE: To investigate the relationship between the Segond fracture and the anterolateral complex of the knee. METHODS: Between January 2014 and March 2020, patients who presented with an anterior cruciate ligament (ACL) tear requiring acute surgical reconstruction (within 10 days from trauma) were evaluated for inclusion in this study. Patients were included if they had an acute ACL tear with an associated Segond fracture (or "Segond lesion") as detected by radiograph or magnetic resonance imaging. The lateral compartment was exposed in all cases using a 5-cm lateral hockey-stick incision, which was carried down to the iliotibial band. The fascia lata was first inspected and then longitudinally divided along its fibers to expose lateral compartment. The posterolateral corner to Gerdy's tubercle anteriorly was exposed and examined. Once the Segond fracture was identified, it was recorded and photographed. RESULTS: Seventeen patients were enrolled in the study. Dissection of the Segond fracture demonstrated attachment to the anterolateral capsule only. No other discernible attachment to the Segond fracture was noted. Surgical exploration of the anterolateral knee did not reveal injury to the iliotibial band. CONCLUSIONS: Careful dissection of Segond fractures during repair revealed that there is a discernible attachment with the anterolateral capsule to the bone injury in all patients with acute ACL tears undergoing surgical reconstruction and no connections to the iliotibial band. CLINICAL RELEVANCE: The precise pathogenesis of Segond fractures has been the subject of debate, partially due to the complexity of the anatomy of the anterolateral aspect of the knee. Proper understanding of the anatomy of type IV ALL injures with Segond fractures is important to improve treatment of these injuries.

Measurement technique for posterior tibial slope on radiographs can affect its relationship to the risk of anterior cruciate ligament rupture.

PURPOSE: The purpose of this study was to determine the most reliable radiographic measurement method to evaluate PTS as a risk factor for ACL reconstruction failure. METHODS: Patients who underwent ACL reconstruction or ACL revision reconstruction between January 2009 and December 2014 by a single surgeon were included. Fifty-two consecutive patients who underwent ACL revision reconstruction were compared to a random selection of 52 patients who underwent primary ACL reconstruction and a control group of 52 patients without ACL injury. ACL reconstruction was performed using either ipsilateral (primary) or contralateral (revision) quadrupled hamstring autograft. Lateral knee radiographs were evaluated using three methods: (1) longitudinal axis, (2) anterior tibial cortex axis, and (3) posterior tibial cortex. RESULTS: A significant difference was found between subjects who underwent ACL reconstruction and control knees (6.79° vs. 5.31°, p = 0.046) using the posterior tibial cortex method. No other statistical significance was found between groups. A multiple linear regression analysis found that the PTS as measured by any method was not affected by the patient's age, sex, height, weight, and BMI. All methods of measurement for PTS demonstrated excellent (ICC > 0.90) intra-rater and inter-rater reliability, but only the posterior tibial cortex method maintained excellent intra-rater and inter-rater reliability (ICC > 0.90) when evaluating patients with ACL revision reconstruction. CONCLUSIONS: The posterior tibial cortex measurement is the most reliable method for analyzing the PTS on lateral knee radiographs in patients undergoing ACL revision reconstruction.

Anterolateral Ligament Repair Augmented With Suture Tape in Acute Anterior Cruciate Ligament Reconstruction.

Several extra-articular surgical techniques in addition to anterior cruciate ligament reconstruction have been proposed to better restore rotational instability of the knee. One option is surgical repair of the anterolateral ligament in acute cases to achieve an anatomic reconstruction. An additional augmentation to the repair could allow a load-sharing-and thus protective-effect for the repair during the healing process. The purpose of this Technical Note is to describe a primary repair of the anterolateral ligament with suture tape augmentation (Internal Brace; Arthrex, Naples, FL) in a patient with an acute anterior cruciate ligament tear.

Surgical Treatment of Segond Fractures in Acute Anterior Cruciate Ligament Reconstruction.

BACKGROUND: The Segond fracture is an avulsion-type fracture located on the anterolateral aspect of the tibia associated with a ligament recently termed the anterolateral ligament. This injury has been described as pathognomonic for an anterior cruciate ligament (ACL) tear and is associated with a higher grade pivot shift. PURPOSE: To present and report 2-year clinical outcomes of a surgical technique for acute ACL reconstruction with fixation of a concomitant Segond fracture. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective chart review was performed of patients who underwent acute reconstruction for a complete ACL tear with concomitant Segond fracture fixation between January 2010 and December 2014; surgery was performed by a single surgeon. Patients underwent direct Segond fracture repair by either suture alone, suture anchor, or cannulated screw fixation based on the size of the lesion, followed by a 2-incision hamstring autograft intra-articular reconstruction. Pre- and postoperative KT-1000 arthrometer assessment, Lachman test, and pivot-shift test were performed, and patients were administered validated subjective outcome surveys. RESULTS: Twelve patients met inclusion criteria for this review. The measured pre- and postoperative objective and subjective scores were significantly improved in all patients. Side-to-side anterior laxity was significantly improved in all patients based on Lachman and KT-1000 arthrometer testing. A significant pivot shift demonstrated preoperatively (3+, n = 11 [92%]; 2+, n = 1 [8%]) was corrected after fixation, except in 1 patient (8%), who maintained a 1+ pivot shift. Lysholm, Tegner, and International Knee Documentation Committee subjective and objective scores were significantly improved. At a minimum 2-year follow-up, no patients reported rerupture, and only 1 patient (8%) underwent a subsequent procedure (a meniscectomy). No major or minor complications were reported, and all patients returned to their previous activity levels at a mean of 6 months postoperatively. CONCLUSION: Direct repair of the Segond fracture and plication of the anterolateral capsule in patients with an ACL rupture and a high-grade pivot shift demonstrate good clinical outcomes, restoration of rotational stability, and maintenance of knee range of motion at 2 years postoperatively, with no major complications.