The Stieda fracture revisited
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SCIENTIFIC ARTICLE
The Stieda fracture revisited Kathryn J. Stevens 1 & Omar M. Albtoush 2 & Amelie M. Lutz 1 Received: 15 August 2020 / Revised: 28 September 2020 / Accepted: 5 October 2020 # ISS 2020
Abstract Objective This study aimed to evaluate injury patterns associated with Stieda avulsion fractures of the medial femoral condyle at the attachment of the proximal MCL. Materials and methods Knee radiographs and MRI scans of 11 patients with Stieda fractures were evaluated by two fellowshiptrained MSK radiologists for fracture origin, integrity of the deep and superficial components of the MCL, medial retinacular structures, posterior oblique ligament, other ligamentous injuries, meniscal tears, and osteochondral injuries. The mechanism of injury and subsequent clinical management were recorded. Results Eight Stieda fractures only involved the meniscofemoral fibers of the deep MCL, two larger Stieda fractures related to both superficial and deep layers, and one fracture only involved the superficial layer. Posteromedial retinacular structures and posterior oblique ligament were injured in all cases. Eight had high-grade ACL injuries, but none had high-grade PCL nor FCL injuries. The proximal anterolateral ligament was injured in seven, including two with associated Segond fractures. Other injuries included posterolateral corner injuries in six, meniscal injuries in seven, and additional fractures in nine, most commonly ACL-associated impaction fractures in the lateral tibiofemoral compartment. None had high-grade chondral injury. None of the Stieda fractures were treated surgically, but four underwent subsequent ACL reconstruction. Conclusion Stieda fractures most commonly involved the deep fibers of the MCL and were accompanied by moderate-to-high-grade injury of other MCL components. There was a high association with other ligamentous injuries, particularly the posterior medial retinacular structures, posterior oblique ligament, and ACL, and many were associated with additional fractures. Keywords Stieda fracture . Avulsion fracture . Medial femoral condyle . Medial collateral ligament . Trauma . Knee . MRI
Introduction The medial collateral ligament (MCL) is one of the most commonly injured ligaments in the knee [1], and is divided into superficial and deep layers (Fig. 1). Stronger superficial fibers (sMCL) arise from the posterior medial femoral epicondyle anterior and distal to the adductor tubercle [2–4], inserting into the posteromedial tibia 6 cm from the medial joint line. Fibers also blend with the posterior oblique ligament (POL), and fascia overlying the anterior arm of the semimembranosus [2, 5]. The sMCL
* Kathryn J. Stevens [email protected] 1
Department of Radiology, Stanford University Medical Center, Grant Building S062A, 300 Pasteur Drive, Stanford, CA 94305, USA
2
Department of Diagnostic and Interventional Radiology, University of Jordan, Queen Rania Street, Amman 11942, Jordan
provides the primary constraint to valgus stress and internal rotation in knee flexion and serves
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