Segond fracture associated with ACL full thickness tear

Case contributed by Dr Mohammad A. ElBeialy

Presentation

Twisting injury

Patient Data

Age: 20 years
Gender: Male

Avulsion fracture of the lateral tibial condyle is noted consistent with a Segond fracture. Deep lateral femoral sulcus sign is noted as well suggestive of ACL injury. Joint effusion.

There is a full thickness tear of the anterior cruciate ligament which appears disrupted, ill-defined and indistinct with increased signal intensity as well as buckling of the posterior cruciate ligament. The posterior portion of the posterior cruciate ligament shows increased signal intensity, a partial thickness tear is present.

Osseous contusion of the lateral femoral condyle is noted with an impacted microtrabecular fracture seen at the lateral femoral notch demonstrating hypointensity as well as hyperintense T2, fat sat and STIR signal intensity.

Avulsion fracture of the lateral tibial condyle is noted consistent with Segond fracture associated with osseous contusion of the posterior and lateral tibial condyles as well as the fibular head with patchy area of hypointense T1 and hyperintense T2, fat sat and STIR signal intensity.

A vertical tear of the posterior horn of the lateral meniscus is noted with no displaced tear or bucket handle component. Heterogeneous signal is seen in the anterior horn of the lateral meniscus.

No significant medial meniscal tear is noted.

Large joint effusion.

The lateral head of the gastrocnemius shows patchy area of hypointensity as well as hyperintensity T2, fat sat and STIR signal intensity consistent with a low grade muscle strain.

Heterogeneous signal intensity is noted around the medial and lateral collateral ligaments which appear otherwise intact with no definite tear. A sprain of the fibular collateral ligament is suspected.

Maintained tibiofemoral and patellofemoral articulations with no evident desiccation. No Baker's cyst, periarticular bursitis or periarticular soft tissue mass lesion.

Case Discussion

Full thickness tear of the anterior cruciate ligament (ACL) with deep sulcus sign of the lateral femoral condyle associated with Segond fracture of the lateral tibial condyle with osseous contusion of the lateral femoral and posterolateral tibial condyles and fibular head as well as torn posterior horn of the lateral meniscus.

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Case information

rID: 53906
Case created: 13th Jun 2017
Last edited: 25th Jun 2017
Inclusion in quiz mode: Included

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