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:
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.