Is it worthwhile fixing Segond fractures for the management of anterolateral knee instability?
DOI:
https://doi.org/10.1016/j.rccot.2020.07.007Keywords:
segond fracture, anterolateral instability, knee, anterior cruciate ligament surgery, anterolateral ligamentAbstract
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.
Evidence Level: IV
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