Arthroscopic Treatment of Tibial Spine Fractures
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Tibial spine fractures are an avulsion of the attachment site of the anterior cruciate ligament on the tibia. They are a relatively rare type of fracture that children (ages 8–14 most commonly) may sustain. They are typically cited at less than 2% of all knee injuries in the pediatric population. The mechanism of injury is classically taught as a fall from a bike landing on a hyperflexed knee. More recent studies have supported that the mechanism of injury is similar to that of adult style anterior cruciate ligament (ACL) injury. This injury represents a failure of the chondroepiphysis. The ACL in children has a greater strength to failure than to the bone to which it is attached. It should be remembered that although the obvious injury happens at the tibial spine, a stretching injury to the anterior cruciate ligament itself can also occur. Tibial spine fractures are classified by the Myers/McKeaver classification: type 1 is minimal displacement, type 2 is anterior half of the fractured tibial spine is elevated with intact posterior hinge, and type 3 is complete avulsion of the tibial spine. A type 4 was added later which is complete displacement with rotation.