Segond fracture: an MR evaluation of 146 patients with emphasis on the avulsed bone fragment and what attaches to it.
OBJECTIVE
To re-evaluate the Segond fragment emphasizing those structures that attach to the fragment in patients with reported acute/subacute anterior cruciate ligament (ACL) injuries, and to clarify the nomenclature used to describe these structures.


METHODS
A search of databases of knee MR examinations over 4.5 years with reported ACL tears yielded 19,726 studies. Using strict exclusion criteria, a total of 146 MR studies with acute/subacute ACL tears were re-assessed with respect to the Segond fragment's size, shape, orientation, location, displacement, attaching soft tissue structures, and associated osseous and/or soft tissue injuries.


RESULTS
Segond fractures were present in 1.25 % of reported acute/subacute ACL tears. The fragment measured 11.9 × 7.3 × 3.27 mm, being thin, ovoid, vertically oriented, situated anterolaterally along the proximal tibial epiphysis, posterior to Gerdy's tubercle and inferior to the lateral tibial plateau, and displaced up to 6 mm laterally. The attached structures were the meniscotibial component of the mid-third lateral capsular ligament (mt-MTLCL) in 58.9 %, both the mt-MTLCL and the posterior fibers of the ITB (pf-ITB) in 35.6 %, and the pf-ITB in 5.48 % of cases. In no case was there an additional attaching structure that did not meet criteria for the mt-MTLCL or the pf-ITB.


CONCLUSIONS
The mt-MTLCL most commonly attaches to the Segond fragment, but the pf-ITB can also attach to this fragment. In no case was there an additional attaching structure that did not meet criteria for the mt-MTLCL or the pf-ITB.
Department of Radiology, University of California San Diego Medical Center, 8899 University Center Lane Suite 370, San Diego, CA, 92122, USA. dyanflores@yahoo.com.
Dyan V
DV
Flores
Department of Radiology, University of California San Diego Medical Center, 8899 University Center Lane Suite 370, San Diego, CA, 92122, USA.
Edward
E
Smitaman
Department of Radiology, University of California San Diego Medical Center, 8899 University Center Lane Suite 370, San Diego, CA, 92122, USA.
Brady K
BK
Huang
Department of Radiology, University of California San Diego Medical Center, 8899 University Center Lane Suite 370, San Diego, CA, 92122, USA.
Donald L
DL
Resnick
D000070598:Anterior Cruciate Ligament Injuries / Q000000981:diagnostic imaging*; D000071562:Fractures, Avulsion / Q000000981:diagnostic imaging*; D006801:Humans; D007719:Knee Joint; D012189:Retrospective Studies; D013977:Tibia; D013978:Tibial Fractures / Q000000981:diagnostic imaging*
Anterior cruciate ligament tear; MRI; Meniscotibial component of the mid-third lateral capsular ligament; Posterior fibers of the iliotibial band; Segond fracture
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