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Ipsilateral ACL injured patients with Segond fractures demonstrate increased posterior tibial slope

Published:August 02, 2022DOI:https://doi.org/10.1016/j.knee.2022.07.009

      Abstract

      Background

      The anterolateral complex has been demonstrated to assist with rotational stability and prevention of anterior tibial translation during the pivot shift. In this study the Segond fracture is used as a surrogate for an anterolateral complex injury to determine if there is an association between Segond fracture and increased posterior tibial slope.

      Methods

      Patients’ charts and radiographs were analyzed retrospectively for the presence of Segond fractures on injury radiographs. These patients, the Segond cohort, were then age and gender matched to a control cohort. Demographic as well MRI measurements of medial and lateral posterior tibial slope and lateral-to-medial slope asymmetry were collected for each cohort. Secondary outcome of anterior cruciate ligament reconstruction failure data was also collected.

      Results

      The Segond group demonstrated a statistically significantly greater lateral posterior tibial slope (8.42° versus 6.55°, P = 0.003) as well as medial posterior tibial slope (6.57° versus 5.34° degrees, P = 0.045). There was no significant differences between lateral-to-medial asymmetry (2.18°versus 1.83°, P = 0.246).

      Conclusion

      Patients with Segond fractures at the time of anterior cruciate ligament injury have increased medial and lateral posterior tibial slope. This may relate to increased rotational and translational instability associated with anterolateral complex injuries. Surgeons treating these patient may use this information to counsel their patients on the risks of associated pathology at the time of arthroscopy such as lateral meniscal posterior root tears.

      Keywords

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      References

        • Segond P.
        Recherches cliniques et experimentales sur les epanchements sanguins du genou par entorse.
        Progres Med. 1879; 7: 297-341
        • Arneja S.S.
        • Furey M.J.
        • Alvarez C.M.
        • Reilly C.W.
        Segond fractures: not necessarily pathognemonic of anterior cruciate ligament injury in the pediatric population.
        Sports Health. 2010; 2: 437-439
        • Shaikh H.
        • Herbst E.
        • Rahnemai-Azar A.A.
        • Bottene Villa Albers M.
        • Naendrup J.H.
        • Musahl V.
        • et al.
        The Segond Fracture Is an Avulsion of the Anterolateral Complex.
        Am J Sports Med. 2017; 45: 2247-2252
        • Vincent J.-P.
        • Magnussen R.A.
        • Gezmez F.
        • Uguen A.
        • Jacobi M.
        • Weppe F.
        • et al.
        The Anterolateral ligament of the human knee: an anatomic and histologic study.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 147-152
        • Claes S.
        • Luyckx T.
        • Vereecke E.
        • Bellemans J.
        Bellemans J The Segond fracture: a bony injury of the anterolateral ligament of the knee.
        Arthroscopy. 2014; 30: 1475-1482
        • Albers M.
        • Shaikh H.
        • Herbst E.
        • Onishi K.
        • Nagai K.
        • Musahl V.
        • et al.
        (2017) The iliotibial band and anterolateral capsule have a combined attachment to the Segond fracture.
        Knee Surg Sports Traumatol Arthrosc. 2018; 26: 1305-1310
        • Getgood A.
        • Brown C.
        • Lording T.
        • Amis A.
        • Claes S.
        • Geeslin A.
        • et al.
        ALC Consensus Group. The anterolateral complex of the knee: results from the International ALC Consensus Group Meeting.
        Knee Surg Sports Traumatol Arthrosc. 2019; 27: 166-176
        • Kittl C.
        • El-Daou H.
        • Athwal K.K.
        • Gupte C.M.
        • Weiler A.
        • Williams A.
        • et al.
        The Role of the Anterolateral Structures and the ACL in Controlling Laxity of the Intact and ACL-Deficient Knee.
        Am J Sports Med. 2016; 44: 345-354
        • Kraeutler M.J.
        • Welton K.L.
        • Chahla J.
        • LaPrade R.F.
        • McCarty E.C.
        Current Concepts of the Anterolateral Ligament of the Knee.
        Am J Sports Med. 2018; 46: 1235-1242
        • Monaco E.
        • Mazza D.
        • Redler A.
        • Lupariello D.
        • Lanzetti R.
        • Guzzini M.
        • et al.
        Segond's fracture: a biomechanical cadaveric study using navigation.
        J Orthop Traumatol. 2017; 18: 343-348
        • Park Y.B.
        • Lee H.J.
        • Ro D.H.
        • Lee G.Y.
        • Kim S.
        • Kim S.H.
        Anterolateral ligament injury has a synergic impact on the anterolateral rotatory laxity in acute anterior cruciate ligament-injured knees.
        Knee Surg Sports Traumatol Arthrosc. 2019; 27: 3334-3344
        • Sonnery-Cottet B.
        • Lutz C.
        • Daggett M.
        • Dalmay F.
        • Freychet B.
        • Niglis L.
        • et al.
        The Involvement of the Anterolateral Ligament in Rotational Control of the Knee.
        Am J Sports Med. 2016; 44: 1209-1214
        • Spencer L.
        • Burkhart T.A.
        • Tran M.N.
        • Rezansoff A.J.
        • Deo S.
        • Caterine S.
        • et al.
        Biomechanical analysis of simulated clinical testing and reconstruction of the anterolateral ligament of the knee.
        Am J Sports Med. 2015; 43: 2189-2197
        • Tavlor M.
        • Eljaja S.
        • Jensen J.T.
        • Siesrma V.D.
        • Krogsgaard M.R.
        The role of the anterolateral ligament in ACL insufficient and reconstructed knees on rotatory stability: a biomechanical study on human cadavers.
        Scand J Med Sci Sports. 2016; 26: 960-966
        • Christensen J.J.
        • Krych A.J.
        • Engasser W.M.
        • Vanhees M.K.
        • Collins M.S.
        • Dahm D.L.
        Lateral tibial posterior slope is increased in patients with early graft failure after anterior cruciate ligament reconstruction.
        AM J Sports Med. 2015; 43: 2510-2514
        • Ni Q.K.
        • Song G.Y.
        • Zhang Z.J.
        • Zheng T.
        • Feng Z.
        • Cao Y.W.
        • et al.
        Steep Posterior Tibial Slope and Excessive Anterior Tibial Translation Are Predictive Risk Factors of Primary Anterior Cruciate Ligament Reconstruction Failure: A Case-Control Study With Prospectively Collected Data.
        Am J Sports Med. 2020; 48: 2954-2961
        • Sauer S.
        • English R.
        • Clatworthy M.
        The Ratio of Tibial Slope and Meniscal Bone Angle for the Prediction fo ACL Reconstruction Failure Risk.
        Surg J. 2018; 4: e152-e159
        • Gaunder C.L.
        • Bastrom T.
        • Pennock A.T.
        Segond Fractures Are Not a Risk Factor for Anterior Cruciate Ligament Reconstruction Failure.
        Am J Sports Med. 2017; 45: 3210-3215
        • Mao Y.
        • Zhang K.
        • Li J.
        • Fu W.
        Supplementary Lateral Extra-articular Tenodesis for Anterolateral Rotatory Instability in Patients Undergoing Single-Bundle Ancterior Cruciate Ligament Reconstructions: A Meta-analysis of Randomized Controlled Trials.
        Orthop J Sports Med. 2021; 9 (23259671211002282)
        • Tanaka M.
        • Vyas D.
        • Moloney G.
        • Bedi A.
        • Pearle A.D.
        • Musahl V.
        What does it take to have a high-grade pivot shift?.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 737-742
        • Hudek R.
        • Schmutz S.
        • Regenfelder F.
        • Fuchs B.
        • Koch P.P.
        Novel measurement technique of the tibial slope on conventional MRI.
        Clin Orthop Relat Res. 2009; 467: 2066-2072
        • Shrout P.E.
        • Fleiss J.L.
        Intraclass correlations: uses in assessing rater reliability.
        Psychol Bull. 1979; 86: 420-428
        • DePhillipo N.N.
        • Zeigler C.G.
        • Dekker T.J.
        • Grantham W.J.
        • Aman Z.S.
        • Kennedy M.I.
        • et al.
        Lateral Posterior Tibial Slope in Male and Female Athletes Sustaining Contact Versus Noncontact Anterior Cruciate Ligament Tears: A Prospective Study.
        Am J Sports Med. 2019; 47: 1825-1830
        • Gwinner C.
        • Janosec M.
        • Wierer G.
        • Wagner M.
        • Weiler A.
        Graft Survivorship After Anterior Cruciate Ligament Reconstruction Based on Tibial Slope.
        Am J Sports Med. 2021; 49: 3802-3808
        • Bernholt D.
        • Dephillipo N.
        • Aman Z.
        • Samuelsen B.
        • Kennedy M.
        • LaPrade R.
        Increased posterior tibial slope results in increased incidence of posterior lateral meniscal root tears in ACL reconstruction patients.
        Knee Surg Sports Traumatol Arthosc. 2021; 29: 3883-3891
        • Kolbe R.
        • Schmidt-Hebbel A.
        • Forkel P.
        • Pogorzelski J.
        • Imhoff A.B.
        • Feucht M.J.
        Steep lateral tibial slope and lateral-to-medial slope asymmetry are risk factors for concomitant posterolateral meniscus root tears in anterior cruciate ligament injuries.
        Knee Surg Sports Traumatol Arthrosc. 2019; 27: 2585-2591
        • Kim S.H.
        • Seo H.J.
        • Seo D.W.
        • Kim K.-I.
        • Lee S.H.
        Lee SH Analysis of risk factors for ramp lesions associated with anterior cruciate ligament injury.
        Am J Sports Med. 2020; 48: 1673-1681
        • Okazaki Y.
        • Furumatsu T.
        • Hiranaka T.
        • Kintaka K.
        • Kodama Y.
        • Kamatsuki Y.
        • et al.
        Steep posterior slope of the medial tibial plateau is associated with ramp lesions of the medial meniscus and a concomitant anterior cruciate ligament injury.
        Asia Pac J Sports Med Arthrosc Rehabil Technol. 2021; 24: 23-28
        • Mouton C.
        • Magosch A.
        • Pape D.
        • Hoffmann A.
        • Nuhrenborger C.
        • Seil R.
        Ramp lesions of the medial meniscus are associated with a higher grade of dynamic rotatory laxity in ACL-injured patients in comparison to patients with an isolated injury.
        Knee Surg Sports Traumatol Arthrosc. 2020; 28: 1023-1028
        • Sonnery-Cottet B.
        • Praz C.
        • Rosenstiel N.
        • Blakeney W.G.
        • Ouanezar H.
        • Kandhari V.
        • et al.
        Epidemiological evaluation of meniscal ramp lesions in 3214 anterior cruciate ligament-injured knees from the SANTI study group database: a risk factor analysis and study of secondary meniscectomy rates following 769 ramp repairs.
        Am J Sports Med. 2018; 46: 3189-3197
        • Lee C.C.
        • Youm Y.S.
        • Cho S.D.
        • Jung S.H.
        • Bae M.H.
        • Park S.J.
        • et al.
        Does Posterior Tibial Slope Affect Graft Rupture Following Anterior Cruciate Ligament Reconstruction?.
        Arthroscopy. 2018; 34: 2152-2155
        • Shelbourne K.D.
        • Benner R.W.
        • Jones J.A.
        • Gray T.
        Posterior Tibial Slope in Patients Undergoing Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft: Analysis of Subsequent ACL Graft Tear or Contralateral ACL Tear.
        Am J Sports Med. 2021; 49: 620-625
        • Slagstad I.
        • Parkar A.P.
        • Strand T.
        • Inderhaug E.
        Incidence and Prognostic Significance of the Segond Fracture in Patients Undergoing Anterior Cruciate Ligament Reconstruction.
        Am J Sports Med. 2020; 48: 1063-1068