The Segond’s Fracture

Segond’s fracture, first described in the late nineteenth century, is a well-recognized radiological indirect sign of an anterior cruciate ligament (ACL) tear. Careful dissection of Segond’s fractures during surgery revealed that there was discernible attachment of the anterolateral capsule to the bone plug in all cases, with no connections to the iliotibial band. Biomechanically, while an isolated lesion of the ACL only affects anterior tibial translation (ATT) during static and dynamic measurements, the addition of Segond’s fracture has a significant effect on axial tibial rotation (ATR), as evaluated with the aid of navigation, resulting in the same effect as an injury of the anterolateral ligament. Because injuries of the secondary restraints often occur in cases of acute ACL tears, the recognition and repair of such lesions should be considered along with ACL reconstruction to better control rotational stability. Direct repair of Segond’s fractures and plication of the anterolateral capsule in patients with ACL rupture and a high-grade pivot shift demonstrate good clinical outcomes and the restoration of rotational stability, with no major complications.