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With the knee flexed to 90 degrees, 12mm posterior tibial translation on femur
2%
29/1264
With the knee flexed to 30 degrees, external rotation increased 15 degrees compared to left knee
4%
52/1264
With the knee in valgus and tibia internally rotated, flexion from an extended position results in reduction of tibia on femur
75%
946/1264
With the knee flexed to 90 degrees, quadriceps activation results in reduction of the tibia on femur
3%
35/1264
With the knee in valgus and tibia externally rotated, flexion from an extended position results in reduction of tibia on femur
15%
187/1264
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This soccer player has likely sustained a right knee anterior cruciate ligament (ACL) rupture, as depicted by the pathognomonic anterolateral proximal tibia avulsion fracture (Ségond fracture). The presence of a Ségond fracture on knee radiographs is highly suggestive of an ACL rupture, and represents an avulsion of the anterolateral ligament (ALL), which is a capsuloligamentous structure. In patients with ACL incompetency, physical exam maneuvers include the anterior drawer, the Lachman test, and the pivot shift test. The pivot shift test is best done with patient relaxed under anesthesia. During the pivot shift test, the knee is extended and internally rotated with a valgus force applied as the knee is brought into flexion. With initial internal rotation, the lateral tibial plateau subluxes anteriorly, and as the knee is brought into flexion, the iliotibial band becomes taut and facilitates reduction of the lateral tibial plateau under the femur. Patel et al. reviewed the prevalence and location of bone bruises associated with ACL injury and implications for mechanism of injury. They reported that the most common bone-bruise combination in all studies was on the lateral femoral condyle and the posterior lateral tibial plateau. They concluded that the bone-bruise patterns in the literature support a valgus-driven ACL injury mechanism, which helps to explain the utility pivot shift maneuver in re-enacting the injury pattern. Song et al. examined the associated findings with bone contusions in patients after acute non-contact ACL injuries. They reported that the presence of bone contusions of the lateral femoral condyle and lateral tibial plateau were significantly associated with a high-grade pivot-shift test, concomitant lateral meniscal lesions, and anterolateral ligament abnormalities. Figure A depicts a right knee avulsion injury from the anterolateral proximal tibia (Ségond fracture). Incorrect Answers: Answer 1: This describes the posterior drawer test, which is consistent with PCL injury. Answer 2: This is a description of the Dial test, seen in posterolateral corner injuries. Answer 4: This describes the quadriceps activation test, where a posteriorly subluxed tibia is reduced anteriorly with quadriceps activation. This test helps diagnose PCL injury. Answer 5: This description of the pivot shift test is incorrect, as the tibia is classically placed in internal rotation, not external rotation.
5.0
(4)
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