Tibial Eminence Fractures
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The tibial eminence, also known as the tibial spine, is the tibial attachment of the anterior cruciate ligament (ACL). Fractures occur when a child falls off a bicycle or is injured while playing sports. The mechanism of this injury is thought to be an internal twisting rotation force of the shin bone (tibia) with a flexed knee.
Tibial eminence fractures were originally thought to be the pediatric equivalents of midsubstance ACL injuries. However, research has shown that higher-velocity injuries are associated with midsubstance ACL tears, whereas slower loading mechanisms are associated with injuries at the tibial eminence.
A thorough examination of the knee is required, as a tibial eminence fracture is often associated with injuries to other knee structures, including the meniscus, cartilage, and ligaments.
Who Is at Risk for Tibial Eminence Fractures?
This condition is most commonly seen in children ages 8 to 14.
How Are Tibial Eminence Fractures Diagnosed?
Our doctors start by taking your child's medical history and performing a physical examination similar to an exam for ACL ruptures. Next, we order a series of knee X-rays to look for fractures. In some cases, we perform an MRI to evaluate for additional injuries and confirm whether any structures (such as the meniscus or meniscal ligament) are entrapped at the fracture site.
What Is the Treatment for Tibial Eminence Fractures?
Treatment aims to achieve anatomic reduction of the fracture, realigning the bone to where it belongs, and depends on the severity:
- For a minimally displaced fracture, treatment may be limited to casting.
- For a more displaced fracture, attempts at closed reduction (repositioning the fracture piece) prior to casting may be done.
- For a severely displaced fracture and one that fails closed reduction, surgery is needed to place the fracture back in an anatomic position. In surgery, any block to reduction can be visualized and removed, and the fracture fixed in place. At the Pediatric and Adolescent Sports Medicine Center of New York, we prefer to treat tibial eminence fractures arthroscopically.
Recent studies highlight a high rate of knee stiffness, known as arthrofibrosis, in children with tibial eminence fractures. We aim to minimize this complication by getting the surgically repaired knee moving as quickly as possible. Children who need surgery typically return to their daily activities after regaining full motion and strength in their affected leg, usually within 3 to 4 months.
When Can My Child Get Back to Full Activities?
After they have regained full motion and strength to the involved leg. This typically takes 3-4 months.