Zhang Zhi-Yu, Wang Hong-de, Wang Si-Yao, Maimaitijiang Pakezhati, Wang Cheng
Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, No. 49, Huayuanbei Road, Haidian District, Beijing, China.
Beijing Key Laboratory of Sports Injuries, Beijing, China.
J Orthop Surg Res. 2024 Dec 4;19(1):824. doi: 10.1186/s13018-024-05311-9.
Segond fracture is considered a component of the anterolateral complex (ALC) injury, yet the underlying cause and clinical outcomes of this bony avulsion remain subjects of debate. Additionally, MRI measurements of altered tibiofemoral position in anterior cruciate ligament (ACL)-injured patients with a Segond fracture have not been reported. The purpose of this study is to measure the rotational tibiofemoral position on MRI in ACL-injured patients with a Segond fracture.
A total of 44 patients with a primary ACL injury and a concomitant Segond fracture were included in the Segond fracture group, with the time from injury to MRI within 3 months. Avulsion was confirmed via preoperative computed tomography (CT) scans. The control group comprised 44 matched patients with primary ACL injury and an MRI-determined ALC injury but without a Segond fracture, also with the time from injury to MRI within 3 months. The MRI-determined ALC injury included injuries to the anterolateral ligament, Kaplan fibers, and anterolateral joint capsule, as identified based on previous studies. Sex, age, and BMI were matched between the two groups using propensity score matching (PSM). Arthroscopic findings, concomitant collateral ligament injuries, and preoperative MRI measurements were compared between the two groups.
The Segond fracture group demonstrated a higher frequency of concomitant patellar and femoral trochlear injuries (p = 0.0110) and lateral collateral ligament injuries (p = 0.0121) compared to the control group. Additionally, significantly increased internal rotational tibial subluxation (IRTS) (p = 0.0095) and axial internal tibial rotation (ITR) (p = 0.0306) were observed in the Segond fracture group. A strong positive correlation was found between IRTS and ITR (r = 0.8201), indicating that these two tibial rotation measurement methods were correlated. No significant differences were observed in the measurements of anteroposterior tibiofemoral position and posterior tibial slope (PTS) between the two groups.
The presence of a Segond fracture was associated with significantly increased internal tibial rotation measured on MRIs, suggesting that this bony avulsion may represent a more severe form of ALC injury in ACL-injured patients and should be managed with caution.
Segond骨折被认为是前外侧复合体（ALC）损伤的一部分，但这种骨撕脱伤的潜在原因和临床结果仍存在争议。此外，尚未有关于Segond骨折的前交叉韧带（ACL）损伤患者胫股位置改变的MRI测量报告。本研究的目的是测量Segond骨折的ACL损伤患者的MRI上的胫股旋转位置。
Segond骨折组共纳入44例原发性ACL损伤并伴有Segond骨折的患者，受伤至MRI检查的时间在3个月内。术前通过计算机断层扫描（CT）证实存在撕脱伤。对照组包括44例匹配的原发性ACL损伤且MRI确定存在ALC损伤但无Segond骨折的患者，受伤至MRI检查的时间也在3个月内。根据既往研究确定，MRI确定的ALC损伤包括前外侧韧带、Kaplan纤维和前外侧关节囊损伤。使用倾向评分匹配（PSM）使两组在性别、年龄和BMI方面相匹配。比较两组的关节镜检查结果、合并的侧副韧带损伤情况以及术前MRI测量结果。
与对照组相比，Segond骨折组髌股滑车损伤（p = 0.0110）和外侧副韧带损伤（p = 0.0121）的发生率更高。此外，Segond骨折组观察到胫骨内旋半脱位（IRTS）（p = 0.0095）和胫骨轴向内旋（ITR）（p = 0.0306）显著增加。IRTS与ITR之间存在强正相关（r = 0.8201），表明这两种胫骨旋转测量方法具有相关性。两组之间胫股前后位置和胫骨后倾（PTS）的测量结果无显著差异。
Segond骨折的存在与MRI测量的胫骨内旋显著增加相关，提示这种骨撕脱伤可能代表ACL损伤患者中更严重的ALC损伤形式，应谨慎处理。
