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Avulsive Injury, Knee
Andrew Sonin, MD, FACR; Kirkland W. Davis, MD, FACR
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Diagnostic Checklist

        TERMINOLOGY

        • Abbreviations

          • Anterior cruciate ligament (ACL); posterior cruciate ligament (PCL); medial collateral ligament (MCL); fibular collateral ligament (FCL); iliotibial band (ITB); medial patellofemoral ligament (MPFL); anterolateral ligament (ALL)
        • 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 ALL
            • Sometimes involves ITB more anteriorly
            • Strong association with 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 MCL on medial tibial rim
            • Associated with tear or tibial avulsion of 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

                                  1. 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
                                  2. Fay K et al: Iliotibial band avulsion fracture: a case report with differential diagnosis. Emerg Radiol. ePub, 2015
                                  3. Malempati C et al: Current arthroscopic concepts in repairing posterior cruciate ligament tibial-sided avulsions. Orthopedics. 38(9):563-9, 2015
                                  4. 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
                                  5. Merrow AC et al: Avulsion fractures of the pediatric knee. Pediatr Radiol. 44(11):1436-45; quiz 1433-6, 2014
                                  6. Claes S et al: Anatomy of the anterolateral ligament of the knee. J Anat. 223(4):321-8, 2013
                                  7. White EA et al: Cruciate ligament avulsion fractures: Anatomy, biomechanics, injury patterns, and approach to management. Emerg Radiol. 20(5):429-40, 2013
                                  8. Reddy D et al: Adolescent Segond fracture with an intact anterior cruciate ligament. Orthopedics. 35(7):e1112-5, 2012
                                  9. 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
                                  10. 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
                                  11. Gottsegen CJ et al: Avulsion fractures of the knee: imaging findings and clinical significance. Radiographics. 28(6):1755-70, 2008
                                  12. Kim JR et al: Cartilaginous avulsion fracture of the tibial spine in a 5-year-old girl. Skeletal Radiol. 37(4):343-5, 2008
                                  13. Hunt DM et al: A review of sleeve fractures of the patella in children. Knee. 12(1):3-7, 2005
                                  14. Mellado JM et al: Avulsion fractures and chronic avulsion injuries of the knee: role of MR imaging. Eur Radiol. 12(10):2463-73, 2002
                                  15. el-Khoury GY et al: Acute and chronic avulsive injuries. Radiol Clin North Am. 35(3):747-66, 1997
                                  16. 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

                                        • Abbreviations

                                          • Anterior cruciate ligament (ACL); posterior cruciate ligament (PCL); medial collateral ligament (MCL); fibular collateral ligament (FCL); iliotibial band (ITB); medial patellofemoral ligament (MPFL); anterolateral ligament (ALL)
                                        • 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 ALL
                                            • Sometimes involves ITB more anteriorly
                                            • Strong association with 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 MCL on medial tibial rim
                                            • Associated with tear or tibial avulsion of 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

                                                                  1. 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
                                                                  2. Fay K et al: Iliotibial band avulsion fracture: a case report with differential diagnosis. Emerg Radiol. ePub, 2015
                                                                  3. Malempati C et al: Current arthroscopic concepts in repairing posterior cruciate ligament tibial-sided avulsions. Orthopedics. 38(9):563-9, 2015
                                                                  4. 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
                                                                  5. Merrow AC et al: Avulsion fractures of the pediatric knee. Pediatr Radiol. 44(11):1436-45; quiz 1433-6, 2014
                                                                  6. Claes S et al: Anatomy of the anterolateral ligament of the knee. J Anat. 223(4):321-8, 2013
                                                                  7. White EA et al: Cruciate ligament avulsion fractures: Anatomy, biomechanics, injury patterns, and approach to management. Emerg Radiol. 20(5):429-40, 2013
                                                                  8. Reddy D et al: Adolescent Segond fracture with an intact anterior cruciate ligament. Orthopedics. 35(7):e1112-5, 2012
                                                                  9. 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
                                                                  10. 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
                                                                  11. Gottsegen CJ et al: Avulsion fractures of the knee: imaging findings and clinical significance. Radiographics. 28(6):1755-70, 2008
                                                                  12. Kim JR et al: Cartilaginous avulsion fracture of the tibial spine in a 5-year-old girl. Skeletal Radiol. 37(4):343-5, 2008
                                                                  13. Hunt DM et al: A review of sleeve fractures of the patella in children. Knee. 12(1):3-7, 2005
                                                                  14. Mellado JM et al: Avulsion fractures and chronic avulsion injuries of the knee: role of MR imaging. Eur Radiol. 12(10):2463-73, 2002
                                                                  15. el-Khoury GY et al: Acute and chronic avulsive injuries. Radiol Clin North Am. 35(3):747-66, 1997
                                                                  16. Lynch JM et al: Avulsion fractures involving the cruciate ligaments. Am Fam Physician. 38(2):173-9, 1988