{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:07:27Z","timestamp":1791389247734,"version":"4.3.3"},"reference-count":31,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,8,8]],"date-time":"2020-08-08T00:00:00Z","timestamp":1596844800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Anatomy"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>In a series of human cadaveric experiments, Dr. Paul Segond first described the avulsion injury occurring at the anterolateral tibial plateau that later took his name. The fracture is thought to arise as a consequence of excessive tibia internal rotation which often also elicits damage to other connective tissue of the knee. The exact mechanism behind the avulsion is, however, unclear. A number of ligamentous structures have been proposed in separate studies to insert into the Segond fragment. Suggestions include the iliotibial band (ITB), biceps femoris and the controversial \u2018anterolateral ligament\u2019 (ALL). Despite increasing knowledge of tibial plateau bony microarchitecture in both healthy and disease states, no studies have yet, to our knowledge, considered the role of tibial sub\u2010entheseal bone structure in pathogenesis of the Segond fracture. The goal of this study was thus to elucidate the differences in trabecular properties at regions across the tibial plateau in order to provide an explanation for the susceptibility of the anterolateral region to avulsion injury. Twenty human tibial plateaus from cadaveric donors were dissected and imaged using a Nikon\u2010XTH225\u2010\u03bcCT scanner with &lt;80\u00a0\u03bcm isotropic voxel size. Scans were reconstructed using MicroView 3D Image Viewer and Analysis Tool. Subsequent virtual biopsy at ten anatomically defined regions of interest (ROI) generated estimates of bone volume fraction (\u2018bone volume divided by total volume\u2019 (BV\/TV)). The overall mean BV\/TV value across all 20 tibiae and all 10 ROIs was 0.271. Univariate repeated\u2010measurements ANOVA demonstrated that BV\/TV values differed between ROIs. BV\/TV values at the Segond site (S\u03b1, S\u03b2 or S\u03b3) were lower than all other ROIs at 0.195, 0.192 and 0.193, respectively. This suggests that, notwithstanding inter\u2010 and intra\u2010specimen variation, the Segond site tends to have a lower trabecular bone volume fraction than entheseal sites elsewhere on the tibia. Since BV\/TV correlates with tensile and torsional strength, the lower BV\/TV at the Segond site could equate to a region of local weakness in certain individuals which predisposes them to an avulsion injury following the application of force from excessive internal rotation. The low BV\/TV recorded at the Segond site also challenges the idea that the fracture occurs due to pull from a discrete \u2018anterolateral ligament\u2019, as the tension exerted focally would be expected to elicit a hypertrophic response in line with Frost's Mechanostat hypothesis. Our data would instead agree with the aforementioned reports of the fibrous band at the Segond site being part of a broader insertion of an \u2018anterolateral complex\u2019.<\/jats:p>","DOI":"10.1111\/joa.13282","type":"journal-article","created":{"date-parts":[[2020,8,8]],"date-time":"2020-08-08T19:09:30Z","timestamp":1596913770000},"page":"1040-1048","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The Segond fracture occurs at the site of lowest sub\u2010entheseal trabecular bone volume fraction on the tibial plateau"],"prefix":"10.1111","volume":"237","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6929-708X","authenticated-orcid":false,"given":"William","family":"Mullins","sequence":"first","affiliation":[{"name":"Human Anatomy Centre Anatomy Building Department of Physiology, Development and Neuroscience University of Cambridge Cambridge 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