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The origin is distal to the LCL
4%
40/949
The origin is anterior to the LCL
26%
246/949
The insertion is halfway between Gerdy's tubercle and fibular head
59%
557/949
The insertion is posterior to the LCL
5%
52/949
The insertion is medial to Gerdy's tubercle
39/949
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The abnormality shown in the radiograph is known as a “Segond fracture.” This is a bony avulsion from the anterolateral tibial plateau and is believed to represent avulsion of the anterolateral ligament (ALL). The ALL insertion is halfway between Gerdy's tubercle and fibular head. ACL tears are common athletic injuries leading to anterior and lateral rotatory instability of the knee. Diagnosis can be suspected clinically with presence of a traumatic knee effusion with increased laxity on Lachman's test but requires MRI studies to confirm diagnosis. Radiographs may reveal a Segond fracture, which is thought to be pathognomonic for the diagnosis of ACL tear. A Segond fracture represents a bony avulsion by the ALL. It is associated with ACL tear 75-100% of the time. Shaikh et al. reviewed the anatomic characteristics of the Segond fracture on plain radiographs and magnetic resonance imaging (MRI). They reported that the Segond fracture occurs at the location of the tibial insertion of the ALL. They concluded that MRI analysis revealed that soft tissue attachments to the Segond fracture were the posterior fibers of the ITB and the lateral capsule in 94% of patients. Kraeutler et al. reviewed the history of the Segond fracture and the ALL. They reported that the ALL originates near the lateral epicondyle of the distal femur and inserts on the proximal tibia near Gerdy's tubercle. They concluded that future studies also must be designed in a prospective comparative manner to compare the clinical outcomes of patients undergoing ACL reconstruction with ALL reconstruction versus without ALL reconstruction alone to discover the true effect of the ALL. Figure A is a radiograph the depicts a Segond fracture of the anterolateral proximal tibia. Illustration A depicts the origin and insertion of the ALL. Incorrect Answers: Answers 1 & 2: The origin of the ALL is believed to be proximal and posterior to the lateral collateral ligament (LCL) Answer 4: The LCL inserts on the fibular head, while the ALL inserts on the anterolateral proximal tibia (near Gerdy's tubercle) Answer 5: The ALL inserts on the anterolateral proximal tibia (near Gerdy's tubercle), but not medial to it
4.0
(5)
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