Originally described by the French surgeon Paul Segond in 1879 after a series of cadaveric experiments, Segond fracture involves cortical avulsion of the tibial insertion of the middle third of the lateral capsular ligament. The mechanism of this injury often is the result of internal rotation of the knee and varus stress, a motion that produces abnormal tension on the lateral capsular ligament. Patients often present with pain of the lateral joint line and anterolateral rotational instability. The Segond fracture is now accepted as an indirect radiographic marker of an anterior cruciate ligament (ACL) tear. Recent cadaveric biomechanical studies documented that association of Segond fracture with sectioned ACL has a dramatic effect on rotatory instability, as revealed by the pivot shift test. When a Segond fracture is identified on radiograph images, fixation of the bone fragment with repair of the torn or stretched ligament is justified in association with intra-articular reconstruction to more comprehensively address knee stability. This video presents several treatment methods for Segond fracture and their effect on pivot shift.