Background:

The Segond fracture can be observed in patients with an anterior cruciate ligament (ACL) tear. It is unclear whether the Segond fracture affects clinical outcomes after ACL reconstruction.

Purpose:

To investigate whether the presence of a concomitant Segond fracture affects clinical outcomes after ACL reconstruction and to compare clinical outcomes when a Segond fracture is repaired surgically or left unrepaired.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

Three databases (PubMed, Embase, Cochrane Library) were searched in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines on July 27, 2020. Relevant studies regarding ACL injury with concomitant Segond fracture treated by primary ACL reconstruction were screened in duplicate. Data regarding patient characteristics and clinical outcomes were extracted. Descriptive data are presented, and a random-effects model was used to pool amenable data.

Results:

A total of 5 studies examining 2418 patients (987 female; 40.8%), mean age 25.4 years, were included in this study. There were 304 patients with a Segond fracture (mean age, 28.1 years; 35.9% female) and 2114 patients without a Segond fracture (mean age, 25.1 years; 41.5% female). Four studies directly compared outcomes between patients with an unrepaired Segond fracture and no Segond fracture. One study reported 12 patients who underwent ACL reconstruction and repair of a Segond fracture. Among 4 studies, 11 of 292 (3.8%) graft failures/revision surgeries were reported in the groups that had Segond fracture, whereas 145 of 2114 (6.9%) graft failures/revision surgeries were reported in groups that did not have Segond fracture. No significant difference was observed in the risk of graft failure between the 2 groups, with a pooled risk ratio of 0.59 (95% CI, 0.32-1.07; P = .08; I² = 0%). No clinically significant differences were observed with regard to International Knee Document Committee score, Lysholm score, Tegner activity scale, and postoperative knee laxity between the group with Segond fracture and those without.

Conclusion:

An unrepaired Segond fracture does not appear to have any significant negative effect on postoperative stability or risk of graft failure or revision surgery after ACL reconstruction. Future prospective studies may be warranted to confirm the finding that patients with combined ACL injury and Segond fracture may have outcomes comparable with those of ACL-injured patients without a Segond fracture when isolated ACL reconstruction is performed.

中文翻译：

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伴有第二段骨折的患者前十字韧带重建后的临床结果：系统评价

背景：

在前十字韧带 (ACL) 撕裂的患者中可以观察到 Segond 骨折。目前尚不清楚 Segond 骨折是否影响 ACL 重建后的临床结果。

目的：

旨在研究伴随的 Segond 骨折的存在是否影响 ACL 重建后的临床结果，并比较手术修复或不修复 Segond 骨折时的临床结果。

学习规划：

系统审查；证据级别，4。

方法：

2020年7月27日按照PRISMA（Preferred Reporting Items for Systematic Reviews and Meta-Analyses）指南检索三个数据库（PubMed、Embase、Cochrane Library）关于初次ACL重建治疗ACL损伤伴Segond骨折的相关研究一式两份进行筛选。提取有关患者特征和临床结果的数据。提供了描述性数据，并使用随机效应模型来汇集合适的数据。

结果：

本研究共纳入 5 项研究，对 2418 名患者（987 名女性；40.8%）进行检查，平均年龄 25.4 岁。有 304 名 Segond 骨折患者（平均年龄 28.1 岁；35.9% 女性）和 2114 名未发生 Segond 骨折的患者（平均年龄 25.1 岁；41.5% 女性）。四项研究直接比较了未修复 Segond 骨折和无 Segond 骨折患者的结局。一项研究报告了 12 名接受 ACL 重建和 Segond 骨折修复的患者。在 4 项研究中，有 Segond 骨折的组报告了 292 例移植失败/翻修手术中的 11 例 (3.8%)，而没有 Segond 骨折的组报告了 2114 例移植失败/翻修手术中的 145 例 (6.9%)。两组之间的移植失败风险没有显着差异，合并风险比为 0.59（95% CI，0.32-1.07；P = .08；I ² = 0%）。在国际膝关节文献委员会评分、Lysholm 评分、Tegner 活动量表和术后膝关节松弛度方面，有 Segond 骨折组与无 Segond 骨折组之间没有观察到临床显着差异。

结论：

未修复的 Segond 骨折似乎不会对术后稳定性或 ACL 重建后移植物失败或翻修手术的风险产生任何显着的负面影响。未来的前瞻性研究可能有必要证实这一发现，即在进行单独的 ACL 重建时，合并 ACL 损伤和 Segond 骨折的患者可能具有与未发生 Segond 骨折的 ACL 损伤患者相当的结果。