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Abstract Background Segond’s fracture is a well-recognised radiological sign of an anterior cruciate ligament (ACL) tear. While previous studies evaluated the role of the anterolateral ligament (ALL) and complex injuries on rotational stability of the knee, there are no studies on the biomechanical effect of Segond’s fracture in an ACL deficient knee. The aim of this study was to evaluate the effect of a Segond’s fracture on knee rotation stability as evaluated by a navigation system in an ACL deficient knee. Materials and methods Three different conditions were tested on seven knee specimens: intact knee, ACL deficient knee and ACL deficient knee with Segond’s fracture. Static and dynamic measurements of anterior tibial translation (ATT) and axial tibial rotation (ATR) were recorded by the navigation system (2.2 OrthoPilot ACL navigation system B. Braun Aesculap, Tuttlingen, Germany). Results Static measurements at 30° showed that the mean ATT at 30° of knee flexion was 5.1 ± 2.7 mm in the ACL intact condition, 14.3 ± 3.1 mm after ACL cut (P = 0.005), and 15.2 ± 3.6 mm after Segond’s fracture (P = 0.08). The mean ATR at 30° of knee flexion was 20.7° ± 4.8° in the ACL intact condition, 26.9° ± 4.1° in the ACL deficient knee (P > 0.05) and 30.9° ± 3.8° after Segond’s fracture (P = 0.005). Dynamic measurements during the pivot-shift showed that the mean ATT was 7.2 ± 2.7 mm in the intact knee, 9.1 ± 3.3 mm in the ACL deficient knee(P = 0.04) and 9.7 ± 4.3 mm in the ACL deficient knee with Segond’s fracture (P = 0.07). The mean ATR was 9.6° ± 1.8° in the intact knee, 12.3° ± 2.3° in the ACL deficient knee (P > 0.05) and 19.1° ± 3.1° in the ACL deficient knee with Segond’s lesion (P = 0.016). Conclusion An isolated lesion of the ACL only affects ATT during static and dynamic measurements, while the addition of Segond’s fracture has a significant effect on ATR in both static and dynamic execution of the pivot-shift test, as evaluated with the aid of navigation.

Introduction: Various, very well established ligaments and menisci form the framework of stability to the knee and all these structures are already being clearly evaluated on an MRI examination. The Anterolateral Ligament (ALL) however is a relatively newly described structure in the knee which is causing a lot of anticipation for its role in rotational stability. Aim: The present study was done with the aim of identifying tears of the anterolateral ligament, classifying them according to the involved segment and to assess the segment wise association of tears of Anterior cruciate ligament (ACL) with Anterolateral Ligament (ALL). Materials and Methods: A study population of 125 patients presenting with post traumatic knee instability were studied for a period of one year and one month. A 1.5T MRI was used for the study with dedicated high resolution sequences. The results were analysed by calculating the number of patients with ALL tears and by analysing how many of these had a segment wise associated tear of the ACL. Results: The results were analysed by calculating the number of patients with ALL tears and by analysing how many of these had a segment wise associated tear of the ACL. Among the study population, 68 (54.40%) participants had a tear of the ACL at its femoral attachment, 24 (19.20%) participants had a mid segment ACL tear and 14 (11.20%) participants had tear of the tibial insertion of the ACL. Among the study population, 47 (37.60%) participants had a tear of the femoral attachment of ALL, 7 (5.60%) had a tear of the meniscal segment of ALL and 8 (6.40%) participants had a tear of the tibial attachment of ALL. Majority of the patients with femoral and tibial attachment tears of the ALL had a corresponding segment tear of the ACL. Conclusion: A strong, segment wise association of tears of ACL and ALL was established by this study when it came to tears involving their femoral attachments and the tibial attachments, thereby ascertaining a causal factor of both ligaments in rotational stability of knee. It is essential that the integrity of ALL is established before an ACL reconstruction.

Background: Segond's fracture is a well-recognised radiological sign of an anterior cruciate ligament (ACL) tear. While previous studies evaluated the role of the anterolateral ligament (ALL) and complex injuries on rotational stability of the knee, there are no studies on the biomechanical effect of Segond's fracture in an ACL deficient knee. The aim of this study was to evaluate the effect of a Segond's fracture on knee rotation stability as evaluated by a navigation system in an ACL deficient knee.Materials and Methods: Three different conditions were tested on seven knee specimens: intact knee, ACL deficient knee and ACL deficient knee with Segond's fracture. Static and dynamic measurements of anterior tibial translation (ATT) and axial tibial rotation (ATR) were recorded by the navigation system (2.2 OrthoPilot ACL navigation system B. Braun Aesculap, Tuttlingen, Germany).Results: Static measurements at 30° showed that the mean ATT at 30° of knee flexion was 5.1 ± 2.7 mm in the ACL intact condition, 14.3 ± 3.1 mm after ACL cut (P = 0.005), and 15.2 ± 3.6 mm after Segond's fracture (P = 0.08). The mean ATR at 30° of knee flexion was 20.7° ± 4.8° in the ACL intact condition, 26.9° ± 4.1° in the ACL deficient knee (P > 0.05) and 30.9° ± 3.8° after Segond's fracture (P = 0.005). Dynamic measurements during the pivot-shift showed that the mean ATT was 7.2 ± 2.7 mm in the intact knee, 9.1 ± 3.3 mm in the ACL deficient knee(P = 0.04) and 9.7 ± 4.3 mm in the ACL deficient knee with Segond's fracture (P = 0.07). The mean ATR was 9.6° ± 1.8° in the intact knee, 12.3° ± 2.3° in the ACL deficient knee (P > 0.05) and 19.1° ± 3.1° in the ACL deficient knee with Segond's lesion (P = 0.016).Conclusion: An isolated lesion of the ACL only affects ATT during static and dynamic measurements, while the addition of Segond's fracture has a significant effect on ATR in both static and dynamic execution of the pivot-shift test, as evaluated with the aid of navigation. [ABSTRACT FROM AUTHOR]

Segond’s fracture is an avulsion fracture of the lateral rim of the tibial plateau. It is described as a “capsular sign” of associated anterior cruciate ligament (ACL) tears. The clinical examination of a traumatically painful knee is often difficult. For this reason the Segond’s fracture is considered a helpful sign for the diagnosis of ACL ruptures. We report an uncommon case of an isolated Segond’s fracture without ACL rupture (or other internal derangement) associated. With this report we have reviewed literature to know the real occurrence of the Segond’s fracture with ACL tears. The question to be answered is if this lesion really is a sign of association of ACL tears. Most of the cases published are isolated and only one paper has analyzed this occurrence precisely. The scientific literature concludes that the Segond’s fracture is a strong indirect sign of ACL’s tear associated in injured knee. [ABSTRACT FROM AUTHOR]