Abstract
BackgroundSegond’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 methodsThree 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).ResultsStatic 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).ConclusionAn 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.
Highlights
In 1879 Paul Segond described a resistant fibrous band in the lateral compartment of the knee, whose traction injury resulted in a cortical avulsion of the lateral proximal tibial plateau [1].The precise pathogenesis of Segond’s fracture has been the subject of debate, partially due to the complexity of the anterolateral ligamentous anatomy
The most important finding of this study is that a combined lesion of anterior cruciate ligament (ACL) and Segond’s fracture resulted in a significant increase in axial tibial rotation (ATR) when compared both to the intact knee and ACL deficient knee in static and dynamic measurements
It is well known that the pivot-shift test is the most reliable test to evaluate rotational stability in the ACL deficient knee, and its disappearance should be the goal of modern ACL surgery [14]
Summary
In 1879 Paul Segond described a resistant fibrous band in the lateral compartment of the knee, whose traction injury resulted in a cortical avulsion of the lateral proximal tibial plateau [1].The precise pathogenesis of Segond’s fracture has been the subject of debate, partially due to the complexity of the anterolateral ligamentous anatomy. Segond demonstrated that an internal rotation and varus stress applied to the knee causes tension on the lateral joint capsule at its midpoint; he believed that a resistant band of tissue produces an avulsion fracture of the lateral tibial plateau, posterior to the insertion of the ileo-tibial tract (ITT). This injury was named Segond’s fracture and numerous studies [2,3,4] have demonstrated an association of Segond’s fracture with tears of the anterior cruciate ligament (ACL) (75–100% of patients), meniscal tears (66–75% of patients), damage to the structures of the posterolateral corner of the knee, and other avulsion injuries.
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