Arcuate sign: avulsion of tip of fibular styloid at attachment of arcuate ligament complex
Segond fracture: avulsion of lateral tibial rim cortex due to anterolateral ligament (ALL)
Sometimes involves iliotibial band (ITB) more anteriorly
Strong association with anterior cruciate ligament (ACL) tear
ALL is current understanding of anatomic structure; formerly was said to be due to lateral capsular ligament
Reverse Segond fracture: avulsion of deep capsular component of medial collateral ligament (MCL) on medial tibial rim
Often associated with tear or tibial avulsion of posterior cruciate ligament (PCL)
Chronic repetitive traction/avulsive conditions
Osgood-Schlatter disease: at patellar tendon insertion on tibial tubercle
Sinding-Larsen-Johansson syndrome: at origin of patellar tendon at inferior pole of patella
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Ultrasonographic Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
CLINICAL ISSUES
Presentation
Treatment
Classification
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
Partezani Helito PV et al: MRI evaluation of the anterolateral ligament and the iliotibial band in acute anterior cruciate ligament injuries associated with Segond fractures. Arthroscopy. 36(6):1679-86, 2020
Beckett R et al: Avulsion fractures of the knee: a review of the pathophysiology, radiographic, and cross-sectional imaging features. Emerg Radiol. 26(6):683-9, 2019
Badrinath R et al: "Multiligamentous" injuries of the skeletally immature knee: a case series and literature review. J Am Acad Orthop Surg Glob Res Rev. 2(10):e079, 2018
De Maeseneer M et al: Segond fracture: involvement of the iliotibial band, anterolateral ligament, and anterior arm of the biceps femoris in knee trauma. Skeletal Radiol. 44(3):413-21, 2015
Fay K et al: Iliotibial band avulsion fracture: a case report with differential diagnosis. Emerg Radiol. ePub, 2015
Malempati C et al: Current arthroscopic concepts in repairing posterior cruciate ligament tibial-sided avulsions. Orthopedics. 38(9):563-9, 2015
Porrino J Jr et al: The anterolateral ligament of the knee: MRI appearance, association with the Segond fracture, and historical perspective. AJR Am J Roentgenol. 204(2):367-73, 2015
Merrow AC et al: Avulsion fractures of the pediatric knee. Pediatr Radiol. 44(11):1436-45; quiz 1433-6, 2014
Claes S et al: Anatomy of the anterolateral ligament of the knee. J Anat. 223(4):321-8, 2013
White EA et al: Cruciate ligament avulsion fractures: anatomy, biomechanics, injury patterns, and approach to management. Emerg Radiol. 20(5):429-40, 2013
Reddy D et al: Adolescent Segond fracture with an intact anterior cruciate ligament. Orthopedics. 35(7):e1112-5, 2012
Kwon OS et al: Medial and lateral segond fractures in a skeletally immature patient: a radiographic marker for the multiply injured knee. Orthopedics. 34(11):e772-5, 2011
Kitamura K et al: Avulsion-tear type medial patellofemoral ligament injury with a small bony fragment in lateral patellar dislocation. J Trauma. 66(1):271-3, 2009
Gottsegen CJ et al: Avulsion fractures of the knee: imaging findings and clinical significance. Radiographics. 28(6):1755-70, 2008
Kim JR et al: Cartilaginous avulsion fracture of the tibial spine in a 5-year-old girl. Skeletal Radiol. 37(4):343-5, 2008
Hunt DM et al: A review of sleeve fractures of the patella in children. Knee. 12(1):3-7, 2005
Mellado JM et al: Avulsion fractures and chronic avulsion injuries of the knee: role of MR imaging. Eur Radiol. 12(10):2463-73, 2002
el-Khoury GY et al: Acute and chronic avulsive injuries. Radiol Clin North Am. 35(3):747-66, 1997
Lynch JM et al: Avulsion fractures involving the cruciate ligaments. Am Fam Physician. 38(2):173-9, 1988
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Imaging
Top Differential Diagnoses
Diagnostic Checklist
TERMINOLOGY
Definitions
Arcuate sign: avulsion of tip of fibular styloid at attachment of arcuate ligament complex
Segond fracture: avulsion of lateral tibial rim cortex due to anterolateral ligament (ALL)
Sometimes involves iliotibial band (ITB) more anteriorly
Strong association with anterior cruciate ligament (ACL) tear
ALL is current understanding of anatomic structure; formerly was said to be due to lateral capsular ligament
Reverse Segond fracture: avulsion of deep capsular component of medial collateral ligament (MCL) on medial tibial rim
Often associated with tear or tibial avulsion of posterior cruciate ligament (PCL)
Chronic repetitive traction/avulsive conditions
Osgood-Schlatter disease: at patellar tendon insertion on tibial tubercle
Sinding-Larsen-Johansson syndrome: at origin of patellar tendon at inferior pole of patella
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Ultrasonographic Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
CLINICAL ISSUES
Presentation
Treatment
Classification
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
Partezani Helito PV et al: MRI evaluation of the anterolateral ligament and the iliotibial band in acute anterior cruciate ligament injuries associated with Segond fractures. Arthroscopy. 36(6):1679-86, 2020
Beckett R et al: Avulsion fractures of the knee: a review of the pathophysiology, radiographic, and cross-sectional imaging features. Emerg Radiol. 26(6):683-9, 2019
Badrinath R et al: "Multiligamentous" injuries of the skeletally immature knee: a case series and literature review. J Am Acad Orthop Surg Glob Res Rev. 2(10):e079, 2018
De Maeseneer M et al: Segond fracture: involvement of the iliotibial band, anterolateral ligament, and anterior arm of the biceps femoris in knee trauma. Skeletal Radiol. 44(3):413-21, 2015
Fay K et al: Iliotibial band avulsion fracture: a case report with differential diagnosis. Emerg Radiol. ePub, 2015
Malempati C et al: Current arthroscopic concepts in repairing posterior cruciate ligament tibial-sided avulsions. Orthopedics. 38(9):563-9, 2015
Porrino J Jr et al: The anterolateral ligament of the knee: MRI appearance, association with the Segond fracture, and historical perspective. AJR Am J Roentgenol. 204(2):367-73, 2015
Merrow AC et al: Avulsion fractures of the pediatric knee. Pediatr Radiol. 44(11):1436-45; quiz 1433-6, 2014
Claes S et al: Anatomy of the anterolateral ligament of the knee. J Anat. 223(4):321-8, 2013
White EA et al: Cruciate ligament avulsion fractures: anatomy, biomechanics, injury patterns, and approach to management. Emerg Radiol. 20(5):429-40, 2013
Reddy D et al: Adolescent Segond fracture with an intact anterior cruciate ligament. Orthopedics. 35(7):e1112-5, 2012
Kwon OS et al: Medial and lateral segond fractures in a skeletally immature patient: a radiographic marker for the multiply injured knee. Orthopedics. 34(11):e772-5, 2011
Kitamura K et al: Avulsion-tear type medial patellofemoral ligament injury with a small bony fragment in lateral patellar dislocation. J Trauma. 66(1):271-3, 2009
Gottsegen CJ et al: Avulsion fractures of the knee: imaging findings and clinical significance. Radiographics. 28(6):1755-70, 2008
Kim JR et al: Cartilaginous avulsion fracture of the tibial spine in a 5-year-old girl. Skeletal Radiol. 37(4):343-5, 2008
Hunt DM et al: A review of sleeve fractures of the patella in children. Knee. 12(1):3-7, 2005
Mellado JM et al: Avulsion fractures and chronic avulsion injuries of the knee: role of MR imaging. Eur Radiol. 12(10):2463-73, 2002
el-Khoury GY et al: Acute and chronic avulsive injuries. Radiol Clin North Am. 35(3):747-66, 1997
Lynch JM et al: Avulsion fractures involving the cruciate ligaments. Am Fam Physician. 38(2):173-9, 1988
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