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With the knee flexed to 90 degrees, 12mm posterior translation of the tibia on the femur
2%
23/1159
Asymmetry in external rotation of 14 degrees at 30 degrees of knee flexion compared to the left knee
7%
79/1159
With the knee in valgus and tibia internally rotated, flexion from an extended position results in posterior subluxation of tibia on femur
51%
586/1159
With the knee flexed to 90 degrees, 15mm anterior translation of the femur on the tibia
16%
181/1159
With the knee in valgus and tibia externally rotated, flexion from an extended position results in anterior subluxation of tibia on femur
21%
242/1159
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This D1 soccer player has likely sustained a right knee anterior cruciate ligament (ACL) injury, 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 flexed from extension, internally rotated, and a valgus force is applied, and the iliotibial band becomes a reducing force, facilitating the 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. 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 and 4: These tests describe the posterior drawer test consistent with PCL injury. Answer 2: This is a description of the Dial test, seen in posterolateral corner injuries. Answer 5: This description of the pivot shift test is incorrect, as the tibia is classically placed in internal rotation, and with flexion from an extended position, the tibia subluxates posteriorly (not anteriorly).
1.1
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