Ricerc@Sapienza

Background Segond’s fracture is a well-recognised radiological
sign of an anterior cruciate ligament (ACL) tear.
While previous studies evaluated the role of the anterolateral
ligament (ALL) and complex injuries on rotational
stability of the knee, there are no studies on the biomechanical
effect of Segond’s fracture in an ACL deficient
knee. The aim of this study was to evaluate the effect of a
Segond’s fracture on knee rotation stability as evaluated by
a navigation system in an ACL deficient knee.
Materials and methods Three different conditions were
tested on seven knee specimens: intact knee, ACL deficient
knee and ACL deficient knee with Segond’s fracture. Static
and dynamic measurements of anterior tibial translation
(ATT) and axial tibial rotation (ATR) were recorded by the
navigation system (2.2 OrthoPilot ACL navigation system
B. Braun Aesculap, Tuttlingen, Germany).
Results Static measurements at 30 showed that the mean
ATT at 30 of knee flexion was 5.1 ± 2.7 mm in the ACL
intact condition, 14.3 ± 3.1 mm after ACL cut
(P = 0.005), and 15.2 ± 3.6 mm after Segond’s fracture
(P = 0.08). The mean ATR at 30 of knee flexion was
20.7 ± 4.8 in the ACL intact condition, 26.9 ± 4.1 in
the ACL deficient knee (P[0.05) and 30.9 ± 3.8 after
Segond’s fracture (P = 0.005). Dynamic measurements
during the pivot-shift showed that the mean ATT was
7.2 ± 2.7 mm in the intact knee, 9.1 ± 3.3 mm in the
ACL deficient knee(P = 0.04) and 9.7 ± 4.3 mm in the
ACL deficient knee with Segond’s fracture (P = 0.07).
The mean ATR was 9.6 ± 1.8 in the intact knee,
12.3 ± 2.3 in the ACL deficient knee (P[0.05) and
19.1 ± 3.1 in the ACL deficient knee with Segond’s
lesion (P = 0.016).
Conclusion An isolated lesion of the ACL only affects
ATT during static and dynamic measurements, while the
addition of Segond’s fracture has a significant effect on
ATR in both static and dynamic execution of the pivot-shift
test, as evaluated with the aid of navigation.