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Current Concepts of the Anterolateral Ligament of the Knee: Anatomy, Biomechanics, and Reconstruction. In 1879, Paul Segond described an avulsion fracture (now known as a Segondfracture) at the anterolateral proximal tibia with the presence of a fibrous band at the location of this fracture. Although references to this ligament were occasionally made in the anatomy literature after Segond's discovery, it was not until 2012 that Vincent et al named this ligament what we know it as today
of this ligament are not well understood. Magnetic resonance imaging and ultrasound have identified the ligament and linked it with the classically described Segondfracture. While the ALL likely plays a role in rotational stability of the knee, further studies investigating the significance of ALL injuries and the role of ALL reconstruction in combination with ACL reconstruction are warranted.
? Also known as Purpura gangrenosa is an acute, often fatal, thrombotic disorder which manifests as blood spots and bruising which rapidly leads to skin necrosis and DIC. It often occurs in neonates but can occur in adults with sepsis. The most common noninfectious aetiology is protein C or S deficiency (acquired or congenital). N meningitidis is the most common infectious cause [ ] Question 3 A Segondfracture is a small avulsion of the lateral tibial plateau. It has been considered pathognomic (...) for what injury? Also what is a reverse Second fracture? This fracture considered pathognomonic for ACL disruption. However, it should be noted that this fracture pattern is being seen with increasing frequency with PCL disruptions – particularly the reverse second fracture (this is an avulsion fracture of the medial proximal tibia, see below). Paul Ferdinand Segond was a French surgeon who not only was a knee specialist but also perfected the vaginal hysterectomy. [ ] Question 4 When a diagnosis
to the incidence, anatomy, morphometry, biomechanics, and histology of the ALL and its relation to the Segondfracture was performed.The incidence of the ALL ranged from 83% to 100%, and this range occurs because of small discrepancies in the definition of the ALL's bony insertions. The ALL originates anterior and distal to the femoral attachment of the lateral collateral ligament. It spans the joint in an oblique fashion and inserts between the fibular head and Gerdy tubercle on the tibia. Exact anatomic (...) and morphometric descriptions vary in the literature, and there are discrepancies regarding the ALL's attachment to the capsule and lateral meniscus. The ALL is a contributor to tibial internal rotation stability, and histologically, it exhibits parallel, crimped fibers consistent with a ligamentous microstructure. The footprint of the ALL has been shown to be at the exact location of the Segond fracture.The ALL is a distinct ligamentous structure at the anterolateral aspect of the knee, and it is likely
of ACL tears, i.e., nonvisualization, discontinuity, abnormal signal intensity, and abnormal shape of the ACL, and five secondary findings, i.e., anterior translation of the tibia relative to the femur (≥7 mm), posterior cruciate ligament angle (<105°), bone contusion, Segondfracture, and the deep sulcus sign, were determined. Knee joint laxity was assessed using the Lachman and pivot shift tests. The associations between MRI findings and clinically assessed knee joint laxity were analyzed
for the so-called Segond avulsion fractures. The aim of this study was to determine the precise position and layer of the lateral knee compartment within which the anterolateral ligament is located, as well as its type.In this study, the anatomical dissection of the lateral segment of 14 cadaveric knees (six male, eight female; seven right, seven left; average age of subjects: 78 years) was performed. The dissection was carried out in keeping with Seebacher, layer by layer.The anterolateral ligament
, respectively. Fibular head avulsion fracture (arrow). Capsular avulsion of the lateral tibial metaphysis (presented in the image below) is called a Segondfracture and is highly associated with ACL tears. Lateral, tibial-metaphyseal, capsular avulsion fracture, termed a Segondfracture (white arrow). Segondfractures are highly associated with anterior cruciate ligament tears. Note the avulsion of the tibial spines (black arrow), indicating an anterior cruciate ligament injury. Previous Next: Magnetic (...) fracture, termed a Segondfracture (white arrow). Segondfractures are highly associated with anterior cruciate ligament tears. Note the avulsion of the tibial spines (black arrow), indicating an anterior cruciate ligament injury. of 24 Tables Contributor Information and Disclosures Author Alex Freitas, MD Assistant Professor, Department of Radiology, University of California, Los Angeles, David Geffen School of Medicine; Assistant Chief of Musculoskeletal Radiology, Renaissance Imaging Medical
. The sensitivity of these signs is limited [ ] ; therefore, the absence of secondary signs in no way excludes ACL disruption. Certain signs, however (discussed below), have greater than 80% specificity for ACL injury. As a consequence, they may allow for a fairly confident diagnosis of tear when primary signs are equivocal. [ , , , , , , , , , , , ] Secondary signs with high specificity for ACL injury include pivot-shift bone bruises/osteochondral fractures and Segondfractures. Pivot-shift bone bruises (...) oblique to the coronal plane but is verticalized in the setting of ACL tear-related anterior tibial translocation. Segondfracture: high association with ACL injury A Segondfracture (see the images below) is a stereotypical fracture of the tibia that has a 75-100% association with ACL tear. [ ] The Segondfracture is an elliptical, vertical, 3 X 10-mm bone fragment paralleling the lateral tibial cortex about 4 mm distal to the plateau. Segondfractures have historically been attributed to traction
, but with the fixation not interfering with the rehabilitation protocol cartilage changes verified on MRI with an arthroscopically determined intact surface. A radiographic examination with normal joint status or combined with either one of the following findings: a small-avulsed fragment located laterally, usually described as a Segondfracture, JSN grade 1 or osteophytes grade 1 as determined by the OARSI atlas15 Exclusion Criteria: Previous major knee injury or knee surgery Associated posterior cruciate ligament
by the investigators. Patient (s) with insurance coverage. Exclusion Criteria: Patients with a bucket handle meniscus tear. Patients with a pentad injury. Patients with osteochondral fragments. Patients with a knee fracture apart from "Segondfracture" and "bone bruise". Patients who underwent ligament surgery for the concerned knee. Patients with a bone lesion which may interfere with the knee joint(distal femur, proximal tibia, patella). Patients with any history of rupture of the central pivot (anterior
the lateral femoral epicondyle to the lateral tibial plateau between the Gerdy tubercle and the fibular head. For each knee, 2 constructs were prepared: (1) a bone-anterolateral capsule-bone specimen and (2) a strip of iliotibial band attached to the Gerdy tubercle. Structural properties, including ultimate load, ultimate elongation, and stiffness, were determined for the anterolateral capsule and the iliotibial band. After tensile testing, plain radiographs were obtained for evaluation of the Segond (...) fracture. A paired t test was used to compare the structural properties of the anterolateral capsule with the iliotibial band. Significance was set at P < .05.Two of the 9 specimens were found to have a discrete thickening of the anterolateral capsule. The iliotibial band had almost 50% higher ultimate load and nearly 3 times higher stiffness (487.9 ± 156.9 N and 73.2 ± 24.1 N/mm, respectively) compared with the anterolateral capsule (319.7 ± 212.6 N and 26.0 ± 11.5 N/mm, respectively) (P < .05
reconstruction with a minimum 2-year follow-up.Case series; Level of evidence, 4.A total of 92 patients underwent a combined ACL and ALL reconstruction. Indications for a combined procedure were associated Segondfracture, chronic ACL lesion, grade 3 pivot shift, high level of sporting activity, pivoting sports, and radiographic lateral femoral notch sign. Patients were assessed pre- and postoperatively with objective and subjective International Knee Documentation Committee (IKDC) score, Lysholm score
examination. Aspiration from joints exhibited hemarthrosis in 52 patients. Arthroscopy revealed ACL ruptures in all patients. Four Segond'sfractures, 26 meniscus tears (8 medial and 18 lateral), 1 osteochondral fracture, and 19 medial collateral ligament ruptures were revealed. Arthroscopy detected only 1 of the 5 ruptures of the posteromedial corner of the medial meniscus, which were noted on arthrography. Three ACL stumps were protruding among the femorotibial joint, which seemed to be restricting full
be needed. Segond'sfracture : this is an avulsion fracture of the lateral tibial condyle immediately beyond the articular surface with the knee. Although not directly a part of the knee joint, it occurs in association with tears of the anterior cruciate ligament (ACL), medial meniscus and lateral capsular ligament, and is thus included here. Knee fracture can result in neurovascular compromise or compartment syndrome. Soft tissue infection or osteomyelitis may occur with open fractures. Other (...) fasciotomy. Long-term outcomes include loss of full range of motion and loss of stability. Possible complications include knee joint deformity, joint stiffness and osteoarthritis. Segond'sfracture [ ] An avulsion fracture of the tip of the lateral tibial condyle. The fracture is a consequence of knee joint injury and is therefore included here, although technically the fracture itself is not within the joint. More than 75% are associated with a tear of the ACL. Associated meniscal tearing is common (66
Segondfracture with anterior cruciate ligament tear in an adolescent The authors report a case of acute knee injury in a 14-year-old teenager. The X-ray showed a so-called Segond'sfracture: a small avulsed bone fragment, elliptical in shape, lying immediately below the external tibial plateau, a few millimeters from the lateral tibial cortex. The fracture site was in the portion of the tibial condyle which is linked to the middle third of the lateral capsule by meniscal tibial fibers (...) . Clinical examination under anesthesia and subsequent arthroscopy revealed a total intrasubstance ACL (anterior cruciate ligament) tear close to the proximal insertion. The authors confirm Segond's report of a possible association of this avulsion fracture with ACL injuries, even in adolescence.