Segond Fracture: Key Indicator of ACL Injury You Shouldn’t Miss

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Segond Fracture

Introduction

Segond fracture is a specific type of avulsion fracture that occurs on the lateral aspect of the proximal tibia, near the tibial plateau. This fracture is closely associated with injuries to the anterolateral ligament (ALL) and other ligamentous structures of the knee joint.

Anatomical Location and Associated Injuries

Segond Fracture Site

• The Segond fracture fragment is typically thin, ovoid, and vertically oriented, located anterolaterally or laterally along the lateral tibial plateau, posterior to Gerdy's tubercle.
• This fracture occurs at the location of the tibial insertion of the anterolateral ligament (ALL).

Associated Ligamentous Injuries

• Segond fracture is often indicative of anterolateral rotatory instability (ALRI) of the knee and is frequently accompanied by severe ligamentous injuries, most commonly:

Involvement of Anterolateral Ligament (ALL)

Several studies have investigated the relationship between Segond fracture and the anterolateral ligament (ALL):

• In a study by Claes et al. (2017), the posterior fibers of the iliotibial band (ITB) and the lateral capsule (the anterolateral ligament) were found to attach to the Segond fracture fragment in 94% of patients.
• Caterine et al. (2016) reported that while MRI was unable to identify a distinct ligamentous attachment, the Segond fracture occurred at the location of the tibial insertion of the ALL, as described in the literature.
• Both the ITB and the ALL may be involved in the Segond avulsion, while the anterior arm of the biceps femoris tendon is not typically involved (Skeletal Radiol. 2015).
• The insertion of the ALL is superior to the insertion of the anterior arm of the biceps femoris (Skeletal Radiol. 2015).

Radiographic Findings

Radiographic studies have described the Segond fracture as a bone avulsion at the tibial attachment of the mid-third lateral capsular ligament, with potential involvement of the anterior arm of the short head of the biceps femoris tendon (Radiographics. 2016).

References

1. Claes, S., Vereecke, E., Maes, M., Victor, J., Verdonk, P., & Bellemans, J. (2013). Anatomy of the anterolateral ligament of the knee. Journal of Anatomy, 223(4), 321-328.
2. Caterine, S., Litchfield, R., Johnson, M., Chronik, B., & Getgood, A. (2016). A cadaveric study of the anterolateral ligament: re-introducing the segond fracture. Skeletal Radiology, 45(12), 1635-1647.
3. Skeletal Radiol. 2015 Mar;44(3):413-21.
4. Radiol Clin North Am. 2018 Nov;56(6):935-951.
5. Am J Sports Med. 2000 Mar-Apr;28(2):191-9.
6. Radiographics. 2016 Oct;36(6):1776-1791.

 

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📌 Segond Fracture and Its Relationship with Anterolateral Ligament

✅  Segond Fracture

• A specific avulsion fracture on the lateral aspect of the proximal tibia, near the tibial plateau.
• Typically thin, ovoid, and vertically oriented, located anterolaterally or laterally along the lateral tibial plateau, posterior to Gerdy's tubercle.
• References: [Skeletal Radiol (2016) 45:1635–1647], [Radiographics. 2016 Oct;36(6):1776-1791]

✅  Association with Anterolateral Ligament (ALL) and Other Ligamentous Injuries

• Indicative of anterolateral rotatory instability (ALRI) of the knee.
• Frequently accompanied by severe ligamentous injuries, such as anterior cruciate ligament (ACL) tear, medial collateral ligament (MCL) tear, medial meniscus tear, and posterolateral corner injury.
• References: [Skeletal Radiol (2016) 45:1635–1647], [Skeletal Radiol. 2015 Mar;44(3):413-21]

✅  Involvement of Anterolateral Ligament (ALL)

• The Segond fracture occurs at the location of the tibial insertion of the anterolateral ligament (ALL).
• The posterior fibers of the iliotibial band (ITB) and the lateral capsule (the anterolateral ligament) have been found to attach to the Segond fracture fragment in a high percentage of patients.
• The anterior arm of the biceps femoris tendon is not typically involved.
• References: [Am J Sports Med. 2017 Aug;45(10):2247-2252], [Skeletal Radiol. 2015 Mar;44(3):413-21]

 

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