Houston Methodist. Leading Medicine

February 2013

Hop Test Correlation Two Years After ACL Reconstruction
to read this article.
Evaluation and Treatment of Overhead Throwing Athletes
to read this article.
Meet our MCSM Physician Team
View a map of our locations
MCSM Athletic Training Services Team
MCSM — Texas Medical Center/San Jacinto
Jeff Collins, LAT
713-724-1009 jdcollins@houstonmethodist.org
Jace Duke ATC, LAT
832-247-6936 jdduke@houstonmethodist.org
Emery Hill ATC, LAT
719-482-0146 eehill@houstonmethodist.org
Michelle Leget ATC, LAT
281-740-2297 mtleget@houstonmethodist.org
Lashelle Brown Okonkwo ATC, LAT
713-299-1246 Lmbrown2@houstonmethodist.org
Layne Schramm ATC, LAT
979-966-3527 lschramm@houstonmethodist.org
Scott Tidwell LAT
936-402-0701 satidwell@houstonmethodist.org
MCSM — Sugar Land
Angela Byrd, LAT
832-584-9038 awbyrd@houstonmethodist.org
Jerry Meins, ATC, LAT
281-386-2620 jdmeins@houstonmethodist.org
Brandon Roberts, ATC, LAT
281-435-4605 wbroberts@houstonmethodist.org
Bill Wissen, ATC, LAT
713-516-5478 wtwissen@houstonmethodist.org
MCSM — West Houston
Richard Gregoire ATC, LAT
281-460-5260 rjgregoire@houstonmethodist.org
MCSM — Willowbrook
Dwight Adsit, ATC, LAT
281-635-3673 rdadsit@houstonmethodist.org
Paula Douglas, ATC, LAT
832-627-7737 prdouglas@houstonmethodist.org
Keith Jahn, ATC, LAT
281-731-7373 kfjahn@houstonmethodist.org
Mike Pace, ATC, LAT
281-702-5322 mbpace@houstonmethodist.org

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Welcome to MCSM News , a new outreach publication for the greater Houston community presented by the Houston Methodist Orthopedics & Sports Medicine (MCSM). Each edition of our monthly e-newsletter will highlight informative, cutting-edge topics pertaining to sports medicine and the care of student athletes.

Please take time to peruse this edition and we encourage you to forward it to your staff, administrators, and health care providers as well as post it in athletic training rooms, class rooms, meeting rooms and locker rooms. This and future editions of MCSM News will be archived on our website — methodistsportsmed.com.

The entire outreach staff at MCSM is ready and willing to assist you, your athletes, and your staff with injury evaluations, referrals to our world class physicians and resources to assist you in caring for your student athletes. Our mission is to provide high quality, cost-effective health care that delivers the best value to the people we serve throughout the greater Houston area.

Please contact your local MCSM athletic training expert listed below with questions or to request additional information.

Meniscus Tear or Segond Fracture?

An athlete who presents with a large joint effusion, joint line tenderness, pain on varas/valgus stress and a painful McMurray's exam can often lead to the impression of a meniscal tear prior to X-ray. Knee X-rays may indicate an avulsion fracture.

Depending on the location of the avulsion fracture below the articular surface of the tibia, one can determine the correct diagnosis of a Segond Fracture (laterally) or a reverse Segond fracture (medially). The traditional Segond fracture is a result of an avulsion of the middle third of the lateral collateral ligament. More recent research suggests that avulsion of the insertion of the iliotibial tract and the anterior oblique band of the fibular collateral ligament to the midportion of the lateral tibia is responsible for the avulsion fracture. The mechanism is traditionally thought to be a secondary restraint after ACL tears.

The injury is varas stress and internal rotation of the tibia on the femur. This maneuver places stress on the IT band and the anterior band of the fibular collateral ligament. Depending on the amount of displacement of the fracture, treatment options vary from rest and non-surgical management to surgical management. Careful examination for concomitant injuries include the following:

  • Tear of the anterior cruciate ligament (75-100%).
  • Injuries of the medial and lateral menisci (66-70%).
  • Avulsion fracture of the fibular head.
  • Avulsion fracture of the Gerdy tubercle

It is essential to make a correct diagnosis to base a plan of treatment. The reverse Segond fracture is described in the literature as an oppositional fracture of the traditional Segond fracture. The mechanism of injury is valgus stress and external rotation of the tibia on the femur.

In contrast to the Segond fracture, the reverse Segond fracture results from a tibial avulsion fracture of the deep portion of the medial collateral ligament (MCL). Most of these injuries are traumatic involving a peripheral tear of the medial meniscus and commonly a tear of the posterior cruciate ligament (PCL). Most reverse Segond fractures are a result of high force traumatic injury involving a valgus force to the knee accompanied by external rotation force. Treatment of the reverse Segond fracture is generally secondary to the damage to ligamentous structures. Ligament reconstruction is often necessary to restore ligamentous stability to the knee. The loss of stability created by the tear and displacement of the deep portion of the MCL are of great concern. The avulsion represented above shows the insertion of the deep fibers of the MCL displaced from their normal insertion. Injuries of this nature are severe, requiring thorough evaluation and considerable attention to a treatment plan that may include surgical intervention to restore valgus stability to the knee.

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