{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T16:08:44Z","timestamp":1789920524194,"version":"4.0.1"},"reference-count":45,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:00:00Z","timestamp":1789862400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:00:00Z","timestamp":1789862400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["arthroscopyjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"abstract":"\n Purpose<\/jats:title>\n To investigate whether anterior cruciate ligament (ACL)\u2010injured knees with Segond fractures are associated with anatomic tibial rotation, increased lateral meniscus tears, and residual rotational instability.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This retrospective cohort study included patients who underwent primary ACL reconstruction (double\u2010bundle hamstrings or rectangular bone\u2013patellar tendon\u2013bone graft) between 2015 and 2023, with \u22652\u2009years of follow\u2010up and second\u2010look arthroscopy. Patients with other ligament injuries (excluding grade 1\u20102 medial collateral ligament injuries), non\u2010Segond fractures, previous knee surgery, open physes, or advanced osteoarthritis were excluded. Based on preoperative radiographs, patients were classified into Segond\u2010positive (S+) and \u2010negative (S\u2212) groups. Outcome measures included pivot\u2010shift test, stress radiographic anterior instability, tibiofemoral rotation angle on magnetic resonance imaging, Lysholm, Tegner, and International Knee Documentation Committee scores measured preoperatively and at 2\u2009years postoperatively. Meniscal tear patterns, treatment, and healing status at second\u2010look arthroscopy were recorded.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n We analyzed 1011 knees comprising 47 S+ knees (4.6%). The S+ group showed significantly smaller tibiofemoral rotation angle values (\u22121.7\u00b0\u2009\u00b1\u20092.5\u00b0 vs 8.9\u00b0\u2009\u00b1\u20097.7\u00b0), higher rates of lateral meniscal injury (91.5% vs 36.9%), and lateral meniscus oblique radial tears (78.7% vs 4.6%) than the S\u2212 group (all\n P<\/jats:italic>\n \u2009<\u2009.001). The S+ group had a significantly higher postoperative pivot\u2010shift test (50.0% vs 6.1%,\n P<\/jats:italic>\n \u2009<\u2009.001). Both groups had similar revision rates and meniscal healing. Patient\u2010reported outcomes improved significantly in both groups, with no intergroup differences. Overall, 64.1% and 81.6% of patients achieved the minimal clinically important difference for the Lysholm and International Knee Documentation Committee scores, respectively. Segond fracture was independently associated with a positive pivot\u2010shift test at 2\u2009years postoperatively (odds ratio, 13.579; 95% confidence interval, 6.824\u201026.970;\n P<\/jats:italic>\n \u2009<\u2009.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Compared with ACL injuries without Segond fractures, ACL injuries associated with Segond fractures were associated with external tibial rotation, increased lateral meniscus oblique radial tears, and greater residual rotational instability 2\u2009years postoperatively.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n Level III, retrospective cohort study.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/arj.70577","type":"journal-article","created":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T15:56:10Z","timestamp":1789919770000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Anterior Cruciate Ligament Injuries With Segond Fractures Are Associated With Lateral Meniscus Oblique Radial Tears and Residual Rotational Instability but Not Anatomic Internal Tibial Rotation, Compared With Those Without Segond Fractures"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3318-9180","authenticated-orcid":false,"given":"Hiroaki","family":"Omae","sequence":"first","affiliation":[{"name":"Zenshukai Hospital Gunma Sports Medicine Research Center Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0150-1395","authenticated-orcid":false,"given":"Shinya","family":"Yanagisawa","sequence":"additional","affiliation":[{"name":"Zenshukai Hospital Gunma Sports Medicine Research Center Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0905-1532","authenticated-orcid":false,"given":"Keiichi","family":"Hagiwara","sequence":"additional","affiliation":[{"name":"Zenshukai Hospital Gunma Sports Medicine Research Center Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3928-0853","authenticated-orcid":false,"given":"Yuhei","family":"Maki","sequence":"additional","affiliation":[{"name":"Zenshukai Hospital Gunma Sports Medicine Research Center Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7238-7262","authenticated-orcid":false,"given":"Masashi","family":"Kimura","sequence":"additional","affiliation":[{"name":"Zenshukai Hospital Gunma Sports Medicine Research Center Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7913-1542","authenticated-orcid":false,"given":"Hirotaka","family":"Chikuda","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Gunma University Graduate School of Medicine Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,20]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.knee.2021.09.008","article-title":"The relationship between a Segond fracture and meniscus injury in patients with anterior cruciate ligament tears","volume":"33","author":"Sulaiman Y","year":"2021","journal-title":"Knee."},{"key":"e_1_2_7_3_1","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1007\/s00590-024-03857-2","article-title":"Segond fracture: An indicator for increased risk of lateral meniscus injury in patients with acute anterior cruciate ligament ruptures","volume":"34","author":"Garra S","year":"2024","journal-title":"Eur J Orthop Surg Traumatol."},{"key":"e_1_2_7_4_1","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.clinimag.2018.09.006","article-title":"Avulsion fracture of the medial collateral ligament association with 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cruciate ligament deficiency: An additional secondary sign on MRI","volume":"206","author":"Vassalou EE","year":"2016","journal-title":"AJR Am J Roentgenol."},{"key":"e_1_2_7_27_1","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s12178-019-09529-7","article-title":"The pivot shift: Current experimental methodology and clinical utility for anterior cruciate ligament rupture and associated injury","volume":"12","author":"Vaudreuil NJ","year":"2019","journal-title":"Curr Rev Musculoskelet Med."},{"key":"e_1_2_7_28_1","first-page":"43","article-title":"Rating systems in the evaluation of knee ligament injuries","author":"Tegner Y","year":"1985","journal-title":"Clin Orthop Relat Res."},{"key":"e_1_2_7_29_1","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1016\/j.arthro.2014.05.043","article-title":"International knee documentation committee knee survey use after anterior cruciate ligament reconstruction: A 2005\u20102012 systematic review and world region 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Segond fracture and associated knee injuries: A case report and review of 13 published cases","volume":"50","author":"Kose O","year":"2016","journal-title":"Acta Orthop Traumatol Turc."},{"key":"e_1_2_7_33_1","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1136\/emermed-2011-200356","article-title":"The Segond fracture: A clue to intra\u2010articular knee pathology","volume":"29","author":"Cosgrave CH","year":"2012","journal-title":"Emerg Med J."},{"key":"e_1_2_7_34_1","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1007\/s00167-020-06151-w","article-title":"Remodified Mason\u2010Allen suture technique concomitant with high tibial osteotomy for medial meniscus posterior root tears improved the healing of the repaired root and suppressed osteoarthritis progression","volume":"29","author":"Kim YM","year":"2021","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_7_35_1","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1016\/j.arthro.2006.04.098","article-title":"The association between posterior\u2010inferior tibial slope and anterior cruciate ligament insufficiency","volume":"22","author":"Brandon ML","year":"2006","journal-title":"Arthroscopy."},{"key":"e_1_2_7_36_1","doi-asserted-by":"crossref","first-page":"232596711987937","DOI":"10.1177\/2325967119879373","article-title":"Increased radiographic posterior tibial slope is associated with subsequent injury following revision anterior cruciate ligament reconstruction","volume":"7","author":"Napier RJ","year":"2019","journal-title":"Orthop J Sports Med."},{"key":"e_1_2_7_37_1","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1016\/j.arthro.2023.07.037","article-title":"Posterior displacement of meniscal ramp lesion is observed on flexed knee magnetic resonance imaging of anterior cruciate ligament\u2010deficient knees","volume":"40","author":"Nonaka 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A robotic analysis of rotational knee stability","volume":"45","author":"Noyes FR","year":"2017","journal-title":"Am J Sports Med."},{"key":"e_1_2_7_42_1","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1177\/0363546520905557","article-title":"Incidence and prognostic significance of the Segond fracture in patients undergoing anterior cruciate ligament reconstruction","volume":"48","author":"Slagstad I","year":"2020","journal-title":"Am J Sports Med."},{"key":"e_1_2_7_43_1","doi-asserted-by":"crossref","first-page":"3898","DOI":"10.1177\/03635465211052521","article-title":"Kinematic analysis of lateral meniscal oblique radial tears in the anterior cruciate ligament\u2010deficient knee","volume":"49","author":"Smith PA","year":"2021","journal-title":"Am J Sports Med."},{"key":"e_1_2_7_44_1","doi-asserted-by":"crossref","first-page":"3796","DOI":"10.1177\/03635465221126506","article-title":"Posterior horn lateral meniscal oblique radial tear in acute anterior cruciate ligament reconstruction incidence and outcomes after all\u2010inside repair: Clinical and second\u2010look arthroscopic evaluation","volume":"50","author":"Jeon YS","year":"2022","journal-title":"Am J Sports Med."},{"key":"e_1_2_7_45_1","doi-asserted-by":"crossref","first-page":"232596712110622","DOI":"10.1177\/23259671211062238","article-title":"Clinical outcomes and osteoarthritis at very long\u2010term follow\u2010up after ACL reconstruction: A systematic review and meta\u2010analysis","volume":"10","author":"Grassi A","year":"2022","journal-title":"Orthop J Sports Med."},{"key":"e_1_2_7_46_1","first-page":"232596712110230","article-title":"Clinical outcomes of anterolateral ligament reconstruction or lateral extra\u2010articular tenodesis combined with primary ACL reconstruction: A systematic review with meta\u2010analysis","volume":"9","author":"Na BR","year":"2021","journal-title":"Orthop J Sports Med."}],"container-title":["Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/arj.70577","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/arj.70577","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/arj.70577","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T15:56:17Z","timestamp":1789919777000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/10.1002\/arj.70577"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,20]]},"references-count":45,"alternative-id":["10.1002\/arj.70577"],"URL":"https:\/\/doi.org\/10.1002\/arj.70577","archive":["Portico"],"relation":{},"ISSN":["0749-8063","1526-3231"],"issn-type":[{"value":"0749-8063","type":"print"},{"value":"1526-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,20]]},"assertion":[{"value":"2025-10-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"arj.70577"}}