Tibial Eminence (Spine) Avulsion

A tibial eminence fracture is a partial or complete fracture of the attachment of the anterior cruciate ligament (ACL), one of the four major ligaments of the knee. The ACL is a ropelike structure that helps keep the normal relationship of the femur (thigh bone) and the tibia (leg bone). This ligament is most important in sports that require pivoting, changing direction (cutting), or jumping and landing. In children the bony attachment of the ACL is more likely to break off (fracture) than the ligament is to tear (sprain). However, this ligament is often stretched in conjunction with the bone pulling off the leg bone (tibia). This is because the bony attachment connects to the leg bone via growth plate cartilage, which is weaker than the ligament. Associated injuries to the collateral ligaments (on either side of the knee) or the meniscus cartilage occur often with this injury. A tibial eminence fracture is caused by force that exceeds the strength of the growth plate. This injury may be as a result of a noncontact injury (landing awkwardly or cutting while cleats are stuck to the ground) or from contact, such as getting tackled at the knee.

Initial treatment consists of medications and ice to relieve pain and reduce the swelling of the knee. If the bone is in the proper position or can be positioned without surgery, immobilization with a brace or cast for four to six weeks is recommended. Crutches may be recommended for walking. If the bones are not in proper position, surgery is usually needed to reposition the bones and hold them with sutures, wires, or screws. After immobilization (with or without surgery), stretching and strengthening of the injured and weakened joint and surrounding muscles (due to the injury and the immobilization) are necessary. These may be done with or without the assistance of a physical therapist or athletic trainer. The sutures, wires, or screws usually do not need to be removed.