case_images: PMC11791121_01
case_images: Preoperative images.. (A) Anteroposterior radiograph. The red arrow indicates the Segond fracture fragment. (B) The three-dimensional CT image showing the Segond fracture fragment (red arrow). (C) The coronal view MR image showing the lateral meniscal tear in the posterior segment (yellow arrow). (D) The Segond fracture site associated with lateral extrusion of the lateral meniscus and a detachment of the joint capsule (red arrow). (E) The sagittal view MR image showing the posterior extrusion of the lateral meniscus (red arrow) and a significant bone bruise-like high-signal area on both tibial and femoral sides (yellow arrows). (F) The sagittal view MR image showing the ACL injury at the femoral attachment site (yellow arrow).. CT: computed tomography; MR: magnetic resonance; ACL: anterior cruciate ligament
case_images: cureus-0017-00000076872-i01.jpg
case_images: PMC11791121_01_cureus-0017-00000076872-i01.jpg
case_images: FIG1
case_images: An anteroposterior radiograph revealed a Segond fracture (Figure 1A). The computed tomography (CT) scan of the knee showed a 7.7x18.4 mm size slightly displaced avulsion fracture fragment in the proximal portion of the lateral tibial condyle (Figure 1B). Magnetic resonance imaging (MRI) showed a radial tear in the posterior segment of the LM (Figure 1C) associated with a 4.7 mm lateral extrusion of the meniscus and a detachment of the joint capsule and the avulsed fragment (Figure 1D). The sagittal view MRI also showed a 6.6 mm posterior extrusion of the LM and a significant bone bruise-like high-signal area (Figure 1E). Furthermore, an ACL injury was noted on the femoral attachment side (Figure 1F).
case_images: Arthroscopic view images at the time of lateral meniscal repair.. (A) ICRS grade I cartilage injury in the weight-bearing area of the femoral side at full extension (black arrow). (B) An arthroscopic view showing no obvious cartilage damage in the tibial side. (C) A complete radial tear of the posterior segment (black arrow). (D) After side-to-side repair of the tear. (E) Anteroposterior view radiograph after the osteosynthesis.. ICRS: International Cartilage Repair Society
case_images: cureus-0017-00000076872-i02.jpg
case_images: PMC11791121_01_cureus-0017-00000076872-i02.jpg
case_images: FIG2
case_images: A 10x10 mm International Cartilage Repair Society (ICRS) grade I cartilage injury was observed in the weight-bearing area of the femoral side at full extension (Figure 2A), whereas no obvious cartilage damage was found in the tibia (Figure 2B). Additionally, a complete radial tear was observed in the posterior segment of the LM (Figure 2C). For the lateral meniscal radial tear, side-to-side repair was performed using two 2-0 Fiberwire sutures (Arthrex Inc., Naples, Florida, United States) with an all-inside technique (Figure 2D). Open reduction and internal fixation was performed for the Segond fracture fragments with the fragment being fixed using a 3 mm half-thread cannulated lag screw (Figure 2E).
case_images: Arthroscopic view images at the time of ACL reconstruction and the postoperative CT image.. (A) After the double-bundle ACL reconstruction with a hamstring tendon (anteromedial portal view). (B) The repaired site of the lateral meniscus (black arrow). (C) The postoperative three-dimensional CT image.. ACL: anterior cruciate ligament; CT: computed tomography
case_images: cureus-0017-00000076872-i03.jpg
case_images: PMC11791121_01_cureus-0017-00000076872-i03.jpg
case_images: FIG3
case_images: The second surgery was performed six weeks after the first surgery, during which double-bundle ACL reconstruction was performed using a hamstring autograft (Figure 3A). Partial healing of the LM was observed at the time of ACL reconstruction (Figure 3B), and the fixed fragment was stable at the reduced site (Figure 3C).
case_images: Arthroscopic view images at the time of debridement. . (A) A free cartilage fragment in front of the reconstructed ACL (yellow arrow). (B) Arthroscopically completely healed site with a scar tissue-like condition (black arrow). (C) The severely damaged cartilage of the femoral condyle (red arrow). (D) The extruded lateral meniscus. Cartilage damage was observed in the middle lesion of the tibial plateau uncovered by the extruded meniscus (red arrow), while the cartilage damage was also observed in the posterior side (yellow arrow).. ACL: anterior cruciate ligament
case_images: cureus-0017-00000076872-i04.jpg
case_images: PMC11791121_01_cureus-0017-00000076872-i04.jpg
case_images: FIG4
case_images: The repaired LM healed completely with a scar tissue-like condition (Figure 4A). However, numerous cartilage fragments and severely damaged cartilage injuries were observed in the femoral condyle and tibial plateau (Figure 4B-4D). Meniscal extrusion was observed in the middle segment (Figure 4D), and the detached cartilage fragments were subsequently debrided.
case_images: MR images two years after ACL reconstruction. . (A) A coronal view slice showing the well-repaired posterior segment of the lateral meniscus (yellow arrow). (B) A coronal view slice showing the slightly extruded middle segment of the lateral meniscus adjacent to the fixed fracture site. (C) A sagittal view slice showing no obvious posterior extrusion of the lateral meniscus. (D) A sagittal view slice showing the reconstructed ACL (yellow arrow).. MR: magnetic resonance; ACL: anterior cruciate ligament
case_images: cureus-0017-00000076872-i05.jpg
case_images: PMC11791121_01_cureus-0017-00000076872-i05.jpg
case_images: FIG5
case_images: At the two-year follow-up, the posterior segment of LM was healed without a gap, while a 2.2 mm lateral extrusion of the middle segment of LM was observed on the coronal view MRI (Figure 5A, 5B). ACL was detected without an obvious abnormal signal (Figure 5D). After the third surgery, the patient did not return to the original competitive level, although the symptoms improved.