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Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
CASE REPORT
Combined ACL reconstruction and Segond fracture fixation fails to abolish anterolateral rotatory instability
  1. Levi Reina Fernandes1,
  2. Herve Ouanezar1,
  3. Adnan Saithna2,3,
  4. Bertrand Sonnery-Cottet1,4
  1. 1Sports Medicine, Centre Orthopédique Santy, Lyon, France
  2. 2Medical Technologies and Advanced Materials, Nottingham Trent University, Clifton Campus, Nottingham, UK
  3. 3Orthopaedic Surgery, Renacres Hospital, Ormskirk, Lancashire, UK
  4. 4Chirurgie Orthopédique, Hôpital privé Jean Mermoz, Lyon, France
  1. Correspondence to Dr Herve Ouanezar, herveortho{at}me.com

Summary

The Segond fracture (SF) is considered pathognomonic of an anterior cruciate ligament (ACL) tear. However, the anatomy of the soft-tissue attachments responsible for the avulsion of SFs has been a cause of controversy. A 31-year-old male patient presented with an injury to his right knee that resulted in ACL tear and a SF. Open SF fixation and arthroscopic ACL reconstruction were performed. The anatomical dissection demonstrated that the avulsion of SFs had occurred because of the tibial attachment of the anterolateral ligament (ALL) with an intact Iliotibial band. At 1-year postoperative follow-up, the ACL graft had restored anterior tibial translation to within normal limits. However, residual rotational knee laxity was observed. This finding highlights that patients with SF may be at increased risk of persistent instability after ACL reconstruction. Consideration should be given to recession of the fixation or augmentation of the ALL when dealing with this injury pattern.

  • knee laxity
  • ligament laxity
  • knee injuries
  • ligament rupture

https://doi.org/10.1136/bcr-2018-224457

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    Footnotes

    • Contributors LRF wrote the first draft of the manuscript. HO edited the draft and wrote the discussion. AS edited the draft and corrected the language. BS-C is the investigator, performed the surgery and performed the clinical follow-up of the patient.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.