Gaunder Christopher L, Bastrom Tracey, Pennock Andrew T
San Antonio Military Medical Center, San Antonio, Texas, USA.
Rady Children's Hospital, San Diego, California, USA.
Am J Sports Med. 2017 Dec;45(14):3210-3215. doi: 10.1177/0363546517726962. Epub 2017 Sep 26.
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.
To compare the incidence of Segond fractures in patients undergoing primary ACL reconstruction compared with those undergoing revision ACL reconstruction in an attempt to determine if the presence of a Segond fracture predisposes to ACL reconstruction failure.
Cross-sectional study; Level of evidence, 3.
A retrospective review of all patients undergoing primary or revision ACL reconstruction between 2007 and 2014 was performed. Demographic data (age, sex, body mass index), 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 radiographs and magnetic resonance imaging. Statistical analysis was performed using a P value of <.05.
A total of 552 patients underwent primary ACL reconstruction, and 47 patients underwent revision ACL reconstruction who met inclusion criteria. The incidence of Segond fractures was 6% in the primary reconstruction group. The fracture fragment averaged 6.6 mm in height and 2.3 mm in width and was displaced a mean of 5.0 mm. The fracture fragment bed was localized at the tibial attachment site of the anterolateral ligament a mean 20.6 mm posterior to the Gerdy tubercle in nearly all patients. After ACL reconstruction, the Segond fracture healed in 90% of patients. The incidence of Segond fractures was 3 times as common in male patients ( P = .02); otherwise, its presence was not associated with any other demographic data, injury variables, or radiographic features ( P > .05). No patients undergoing revision surgery had a Segond fracture, and no patient with a Segond fracture had graft failure.
Patients with a Segond fracture are at no higher risk to require revision ACL reconstruction compared with 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 early ACL graft failure.
当诊断出前交叉韧带(ACL)撕裂时可能会发现Segond骨折,其可能代表外侧韧带的撕脱伤。目前尚不清楚在ACL重建时这些骨折是否可以忽略,或者是否应进行手术治疗。
比较初次ACL重建患者与翻修ACL重建患者中Segond骨折的发生率,以确定Segond骨折的存在是否会导致ACL重建失败。
横断面研究;证据等级,3级。
对2007年至2014年间所有接受初次或翻修ACL重建的患者进行回顾性研究。记录人口统计学数据(年龄、性别、体重指数)、损伤变量(损伤的急性程度、损伤机制)和影像学特征(合并韧带损伤、生长板状态)。使用X线片和磁共振成像对每个Segond骨折的具体位置、大小、移位和愈合情况进行分析。采用P值<0.05进行统计学分析。
共有552例患者接受了初次ACL重建,47例患者接受了符合纳入标准的翻修ACL重建。初次重建组中Segond骨折的发生率为6%。骨折块平均高度为6.6mm,宽度为2.3mm,平均移位5.0mm。几乎所有患者的骨折块床均位于外侧韧带在胫骨的附着点,平均在Gerdy结节后方20.6mm处。ACL重建后,90%的患者Segond骨折愈合。Segond骨折在男性患者中的发生率是女性患者的3倍(P = 0.02);此外,其存在与任何其他人口统计学数据、损伤变量或影像学特征均无关联(P > 0.05)。接受翻修手术的患者均无Segond骨折,且有Segond骨折的患者均无移植物失败。
与没有Segond骨折的患者相比,有Segond骨折的患者进行ACL翻修重建的风险并不更高。这可能归因于其高愈合率。在初次ACL重建时,如果发现Segond骨折,可以忽略(不修复或重建),这种方法似乎不会导致早期ACL移植物失败。