Segond Fracture: A Risk Factor for Anterior Cruciate Ligament Reconstruction Failure?

OBJECTIVES: Segond fractures may be identified when an anterior cruciate ligament (ACL) tear is diagnosed and likely represent an avulsion of the anterolateral ligament. It is currently unclear whether these fractures can be ignored at the time of ACL reconstruction or if they should be addressed surgically. The purpose of this study was to compare the incidence of Segond fractures in patients undergoing a primary ACL reconstruction compared to those undergoing a revision ACL reconstruction in an attempt to determine if the presence of a Segond fracture predisposes to ACL reconstruction failure. METHODS: A retrospective review of all patients undergoing a primary or revision ACL reconstruction between January 2007 and June 2014 was performed. Demographic data (age, gender, and BMI), injury variables (acuity, mechanism of injury), and radiographic features (concomitant ligamentous injuries, growth plate status) were documented. Each Segond fracture was analyzed for its specific location, size, displacement, and healing using both radiographic images and MRI. Statistical analysis was performed using a p value of <0.05. RESULTS: The incidence of Segond fractures was 6%. The fracture fragment averaged 6.6 mm in height, 2.3 mm in width, and was displaced 5.0 mm. The fracture fragment bed was localized at the tibial attachment site of the anterolateral ligament 21 mm posterior to Gerdy’s tubercle in nearly all cases. Post-ACL reconstruction, the Segond fracture healed in 90% of cases. The incidence of a Segond fracture was twice as common in male patients (p=0.02), otherwise its presence was not associated with any other demographic data, injury variables, or radiographic features (p>0.05) (Table 1). No patients undergoing a revision surgery had a Segond fracture and no patient with a Segond fracture had a graft failure. CONCLUSION: Segond fractures are relatively uncommon in adolescent patients undergoing ACL surgery (6%). This injury occurs from an avulsion of the lateral joint capsule or the anterolateral ligament (ALL). Patients with a Segond fracture are at no higher risk to require a revision ACL reconstruction compared to patients without a Segond fracture. This may be attributable to its high union rate. At the time of primary ACL reconstruction, if a Segond fracture is identified, it can be ignored (not repaired or reconstructed) and this approach does not appear to predispose to ACL graft failure.