Arthroscopic Treatment of Tibial Spine Fractures

Living reference work entry


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.


Anterior Cruciate Ligament Anterior Horn Accessory Portal Cannulated Screw Tibial Spine 
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References and Suggested Reading

  1. Edmonds E, Fornari E, Dashe J, Roocroft J, King M, Pennock A (2015) Results of displaced pediatric tibial spine fractures: a comparison between open, arthroscopic, and closed management. J Pediatr Orthop 35:651–656CrossRefPubMedGoogle Scholar
  2. Gans I, Baldwin K, Ganley T (2013) Treatment and management outcomes of tibial eminence fractures in pediatric patients. Am J Sports Med 42:1743–1750CrossRefPubMedGoogle Scholar
  3. McLennan J (1995) Lessons learned after second-look arthroscopy in type III fractures of the tibial spine. J Pediatr Orthop 15:59–62CrossRefPubMedGoogle Scholar
  4. Mitchell J, Sjostrom R, Mansour A, Irion B, Hotchkiss M, Terhune B, Carry P, Stewart J, Vidal A, Rhodes J (2015) Incidence of meniscal injury and chondral pathology in anterior tibial spine fractures of children. J Pediatr Orthop 35:130–135CrossRefPubMedGoogle Scholar
  5. Shea K, Grimm N, Loar T, Wall E (2011) Bone bruises and meniscal tears on MRI in skeletally immature children with tibial eminence fractures. J Pediatr Orthop 31:150–152CrossRefPubMedGoogle Scholar

Authors and Affiliations

  1. 1.Department of Pediatric OrthopedicsNemours Children’s Specialty CareJacksonvilleUSA

Section editors and affiliations

  • Eric D. Shirley
    • 1
  1. 1.OrthopaedicsNemours Children's ClinicJacksonvilleUSA

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