This female recreational player presented following an acute injury to her left knee. She described being hit from the lateral side sustaining a forced valgus injury. She was unable to continue, was carried from the field and developed rapid (and significant) swelling. On examination she was unable to weight-bear.
The AP x-ray show a reverse Segond injury – an avulsion from the medial aspect of the medial tibial plateau. This fracture occurs at the insertion of the meniscotibial ligament. The fracture is further defined on MRI. This imaging shows that the remainder of the medial ligament complex is thickened and oedematous at the proximal insertion and distally in keeping with at least a grade 1 injury. There is a fracture of the tibial plateau, predominantly subchondral fracturing but there are two small extensions to the articular surface but no significant step seen.
This player was managed in a range of motion brace for almost six weeks. She then had a further six weeks of limited loading. During this time she completed pool and cycle based training. At three months post-injury she started a slow walk-jog programme. While this was tolerated well she decided against returning to football.
A reverse Segond fracture is an avulsion fracture of the knee, caused by avulsion of the deep fibres of the medial collateral ligament (also known as the menisciotibial or coronary ligament). The fracture involves the medial aspect of the proximal tibia adjacent to the articular surface. It is the opposite of a Segond fracture (which involves the lateral tibia). The reverse Segond fracture is caused by forced external rotation of the knee, with a valgus stress. Compared with a Segond fracture, the reverse Segond appears to occur with higher velocity injuries and may be associated with knee dislocation.
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