Abstract
Objectives:
Recent interest in lesions of the anterolateral structures is noted as a cause of rotational instability in conjunction with anterior cruciate ligament rupture. Imaging studies have been mainly performed with the use of MRI. The incidence of bone avulsions in relation to the anterolateral ligament (Segond lesion) was found between 3 and 6 % in MRI studies with anterior cruciate ligament rupture. We presented that ultrasound imaging in case of the acute anterior cruciate ligament rupture could give higher incidence because there is less distortion by hematoma, and it is easier to move the probe around the anterolateral tibia with more 3D orientation.
Methods:
In 88 patients with an ACL lesion ultrasonography was performed in the acute setting, before four weeks after the injury. Scoring was performed for the diagnosis of lateral femoral condyle impression (over 2 mm), Segond avulsion, medial collateral ligament and meniscus injury. Imaging was performed in both supine and prone position. Imaging of the anterolateral part of the tibia showed Segond lesions in connection with anterolateral ligament.
Results:
Of 88 ACL injuries, 40 % was sustained with football injuries and 28 % with alpine skiing. The incidence rate for Segond avulsion was 29 % ( N = 25 ) There was a 100 % correlation of Segond lesions with impaction fracture of the femoral condyle, which seems to be due to the mechanism of subluxation of the lateral compartment Incidence of meniscus injury in the patients with Segond avulsion was lower but substantial, with 86 % medial meniscus and 29 % lateral meniscus lesions. Treatment of combined ACL / ALL complex avulsions in fresh injuries was performed by first stapling of the lesion, followed by recessing and pulling the lesion into a small drill hole anterolateral to anteromedial in combination with ACL reconstruction as an add on procedure in 16 patients. Stapling was followed by a high percentages of secondary surgery for removal of the staple. Pulling the lesion into a recessed drill hole allowed adjusting the pulling to restoration of arthroscopic lateral plateau position in relation to the lateral meniscus.
Conclusion:
The incidence of Segond lesions in MRI was previously recorded between 3 and 6 % in MRI and of around 9 % in X ray. In our study the incidence as found with Ultrasound Imaging is much higher. We found the incidence to be 29 %, with 25 out of 88 patients. There was also a 100 % relation with impaction of the lateral femoral condyle. Both the lesions might be pointing to the possibility of refixation instead of reconstruction of anterolateral structures in case of anterolateral avulsion.