SpringerLink
Log in

Tibial Spine Fractures

  • Living reference work entry
  • First Online:
Orthopaedic Sports Medicine

  • 9 Accesses

Abstract

Tibial spine (eminence) fractures are often referred to as the pediatric equivalent of an adult anterior cruciate ligament (ACL) tear. They occur predominantly in the pediatric population owing to the relative weakness of their ligaments and incomplete ossification of epiphyseal bone. Historically, these fractures were caused mostly by bicycle accidents, but more recently are mainly because of sporting activities. Diagnosis is made with a combination of the patient’s history, physical exam, and often confirmed with a radiographic image. These fractures are classified using the Meyers and McKeever system, which is based on the radiographic appearance of the fracture and degree of displacement. Surgical and nonoperative treatments exist for these fractures depending on the presentation and severity of the injury. Persistent laxity, loss of range of motion, and arthrofibrosis can be seen after treatment. However, long-term outcomes of treatment are favorable, regardless of treatment option.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Edmonds EW, Fornari ED, Dashe J, Roocroft JH, King MM, Pennock AT. Results of displaced pediatric tibial spine fractures: a comparison between open, arthroscopic, and closed management. J Pediatr Orthop. 2015;35(7):651–6.

    Article  PubMed  Google Scholar 

  2. LaFrance RM, Giordano B, Goldblatt J, Voloshin I, Maloney M. Pediatric tibial eminence fractures: evaluation and management. J Am Acad Orthop Surg. 2010;18:395–405.

    Article  PubMed  Google Scholar 

  3. Axibal DP, Mitchell JJ, Mayo MH, Chahla J, Dean CS, Palmer CE, et al. Epidemiology of anterior tibial spine fractures in young patients: a retrospective cohort study of 122 cases. J Pediatr Orthop. 2019;39(2):E87–90.

    Article  PubMed  Google Scholar 

  4. Askenberger M, Ekström W, Finnbogason T, Janarv PM. Occult intra-articular knee injuries in children with hemarthrosis. Am J Sports Med. 2014;42(7):1600–6.

    Article  PubMed  Google Scholar 

  5. Shin YW, Uppstrom TJ, Haskel JD, Green DW. The tibial eminence fracture in skeletally immature patients. Curr Opin Pediatr. 2015;27:50–7.

    Article  PubMed  Google Scholar 

  6. Kraus T, Ǩvehlík M, Singer G, Schalamon J, Zwick E, Linhart W. The epidemiology of knee injuries in children and adolescents. Arch Orthop Trauma Surg. 2012;132(6):773–9.

    Article  CAS  PubMed  Google Scholar 

  7. Johnson AC, Wyatt JD, Treme G, Veitch AJ. Incidence of associated knee injury in pediatric tibial eminence fractures. J Knee Surg. 2014;27(3):215–9.

    PubMed  Google Scholar 

  8. Mitchell JJ, Sjostrom R, Mansour AA, Irion B, Hotchkiss M, Terhune EB, et al. Incidence of meniscal injury and chondral pathology in anterior tibial spine fractures of children. J Pediatr Orthop. 2015;35(2):130–5.

    Article  PubMed  Google Scholar 

  9. Kocher MS, Micheli LJ, Gerbino P, Hresko MT. Tibial eminence fractures in children: prevalence of meniscal entrapment. Am J Sports Med. 2003;31(3):404–7.

    Article  PubMed  Google Scholar 

  10. Aderinto J, Walmsley P, Keating JF. Fractures of the tibial spine: epidemiology and outcome. Knee. 2008;15(3):164–7.

    Article  CAS  PubMed  Google Scholar 

  11. Monto RR, Cameron-Donaldson ML, Close MA, Ho CP, Hawkins RJ. Magnetic resonance imaging in the evaluation of tibial eminence fractures in adults. J Knee Surg. 2006;19(3):187–90.

    Article  PubMed  Google Scholar 

  12. Accousti WK, Willis RB. Tibial eminence fractures. Orthop Clin North Am Elsevier. 2003;34:365–75.

    Google Scholar 

  13. Fyfe IS, Jackson JP. Tibial intercondylar fractures in children: a review of the classification and the treatment of mal-union. Injury. 1981;13:165–9.

    Article  CAS  PubMed  Google Scholar 

  14. Ziegler CG, Pietrini SD, Westerhaus BD, Anderson CJ, Wijdicks CA, Johansen S, et al. Arthroscopically pertinent landmarks for tunnel positioning in single-bundle and double-bundle anterior cruciate ligament reconstructions. Am J Sports Med. 2011;39(4):743–52.

    Article  PubMed  Google Scholar 

  15. Petersen W, Zantop T. Anatomy of the anterior cruciate ligament with regard to its two bundles, vol. 454. In: Clin Orthop Relat Res; 2007. p. 35–47.

    Google Scholar 

  16. Meyers MH, FM MK. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am. 1959;41-A(2):209.

    Article  CAS  PubMed  Google Scholar 

  17. Grönkvist H, Hirsch G, Johansson L. Fracture of the anterior tibial spine in children. J Pediatr Orthop. 1984;4(4):465–8.

    Article  PubMed  Google Scholar 

  18. Reynders P, Reynders K, Broos P. Pediatric and adolescent tibial eminence fractures: arthroscopic cannulated screw fixation. J Trauma. 2002;53(1):49–54.

    Article  PubMed  Google Scholar 

  19. Kocher MS, Mandiga R, Klingele K, Bley L, Micheli LJ. Anterior cruciate ligament injury versus tibial spine fracture in the skeletally immature knee: a comparison of skeletal maturation and notch width index. J Pediatr Orthop. 2004;24(2):185–8.

    Article  PubMed  Google Scholar 

  20. Willis RB, Blokker C, Stoll TM, Paterson DC, Galpin RD. Long-term follow-up of anterior tibial eminence fractures. J Pediatr Orthop. 1993;13(3):361–4.

    Article  CAS  PubMed  Google Scholar 

  21. Wiley JJ, Baxter MP. Tibial spine fractures in children. Clin Orthop Relat Res. 1990;255:54–60.

    Article  Google Scholar 

  22. Coyle C, Jagernauth S, Ramachandran M. Tibial eminence fractures in the paediatric population: a systematic review. J Child Orthop. 2014;8(2):149–59.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Wilfinger C, Castellani C, Raith J, Pilhatsch A, Höllwarth ME, Weinberg AM. Nonoperative treatment of tibial spine fractures in children-38 patients with a minimum follow-up of 1 year. J Orthop Trauma. 2009;23(7):519–24.

    Article  PubMed  Google Scholar 

  24. Meyers AL, Nelson R. Tibial eminence fractures. StatPearls [Internet]. 2021;(Jul 26)

    Google Scholar 

  25. Zaricznyj B. Avulsion fracture of the tibial eminence: treatment by open reduction and pinning. J Bone Jt Surg – Ser A. 1977;59(8):1111–4.

    Article  CAS  Google Scholar 

  26. Zhang K, Catapano M, Carsen S, Peterson D, De Sa D. Management and complications in nonoperative fractures of the tibial spine: a systematic review. J Pediatr Orthop. 2021;41:e272–8.

    Article  PubMed  Google Scholar 

  27. Adams AJ, Talathi NS, Gandhi JS, Patel NM, Ganley TJ. Tibial spine fractures in children: evaluation, management, and future directions. J Knee Surg. 2018;31(05):374–81.

    Article  PubMed  Google Scholar 

  28. Gans I, Ganley TJ. Tibial eminence fractures: a review and algorithm for treatment. Univ Pa Orthop J. 2013;23:1–4.

    Google Scholar 

  29. Cannamela PC, Quinlan NJ, Maak TG, Adeyemi TF, Aoki SK. Knee extension does not reliably reduce acute type II tibial spine fractures: MRI evaluation of displacement during extension versus resting flexion. Orthop J Sports Med. 2019;7(7):232596711986006.

    Article  Google Scholar 

  30. Patel NM, Park MJ, Sampson NR, Ganley TJ. Tibial eminence fractures in children: earlier posttreatment mobilization results in improved outcomes. J Pediatr Orthop. 2012;32(2):139–44.

    Article  PubMed  Google Scholar 

  31. Group TSR, Prasad N, Aoyama JT, Ganley TJ, Henry B, Ellis J, Mistovich RJ, et al. A comparison of nonoperative and operative treatment of type 2 tibial spine fractures. Orthop J Sports Med. 2021;9(1):232596712097541. https://doi.org/10.1177/2325967120975410.

    Article  Google Scholar 

  32. Louis ML, Guillaume JM, Launay F, Toth C, Jouvre JL, Bollini G. Surgical management of type II tibial intercondylar eminence fractures in children. J Pediatr Orthop Part B. 2008 Sep;17(5):231–5.

    Article  Google Scholar 

  33. Ganley TJ, Brusalis CM. Surgical reduction and fixation of tibial spine fractures in children: multiple fixation strategies. JBJS Essent Surg Tech. 2016;6(2):e18.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Parikh SN, Myer D, Eismann EA. Prevention of arthrofibrosis after arthroscopic screw fixation of tibial spine fracture in children and adolescents. Orthopedics. 2014;37(1):e58.

    Article  PubMed  Google Scholar 

  35. Shelbourne KD, Wilckens JH, Mollabashy A, Decarlo M. Arthrofibrosis in acute anterior cruciate ligament reconstruction: the effect of timing of reconstruction and rehabilitation. Am J Sports Med. 1991;19(4):332–6.

    Article  CAS  PubMed  Google Scholar 

  36. Gans I, Baldwin KD, Ganley TJ. Treatment and management outcomes of tibial eminence fractures in pediatric patients: a systematic review. Am J Sports Med. 2014;42:1743–50.

    Article  PubMed  Google Scholar 

  37. Kocher MS, Foreman ES, Micheli LJ. Laxity and functional outcome after arthroscopic reduction and internal fixation of displaced tibial spine fractures in children. Arthrosc – J Arthrosc Relat Surg. 2003;19(10):1085–90.

    Article  Google Scholar 

  38. Baxter MP, Wiley JJ. Fractures of the tibial spine in children. An evaluation of knee stability. J Bone Jt Surg – Ser B. 1988;70(2):228–30.

    Article  CAS  Google Scholar 

  39. Corrigan JP, Cashman WF, Brady MP. Proprioception in the cruciate deficient knee. J Bone Jt Surg – Ser B. 1992;74(2):247–50.

    Article  CAS  Google Scholar 

  40. Gibson ASC, Lambert MI, Durandt JJ, Scales N, Noakes TD. Quadriceps and hamstrings peak torque ratio changes in persons with chronic anterior cruciate ligament deficiency. J Orthop Sports Phys Ther. 2000;30(7):418–27.

    Article  Google Scholar 

  41. Chhabra A, Elliott CC, Miller MD. Normal anatomy and biomechanics of the knee. Sports Med Arthros Rev. Lippincott Williams and Wilkins. 2001;9:166–77.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, Western University, London, ON, Canada

    Olumide Olotu

  2. School of Medicine, University of Ottawa, Ottawa, ON, Canada

    Sherif El Meniawy

  3. Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada

    Darren de SA

Authors
  1. Olumide Olotu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sherif El Meniawy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Darren de SA
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Darren de SA .

Editor information

Editors and Affiliations

  1. FIFA Medical Centre of Excellence, Clínica Espregueira, Porto, Portugal

    João Espregueira-Mendes

  2. Dept. Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden

    Jón Karlsson

  3. UPMC Freddie Fu SportsMed Ctr, Orth Surg, University of Pittsburgh, Pittsburgh, PA, USA

    Volker Musahl

  4. McMaster University, Hamilton, ON, Canada

    Olufemi R. Ayeni

Section Editor information

  1. Twin Cities Orthopedics, Edina, MN, USA

    Robert F. LaPrade

  2. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    Freddie H. Fu

  3. Department Orthopedic Surgery, Parc de Salut Mar (Hospitals del Mar i de l'Esperança) Universitat Autònoma de Barcelona (UAB),, Barcelona, Spain

    Juan C. Monllau

  4. Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan

    Norimasa Nakamura

  5. Global Centre for Medical Engineering and Informatics, Osaka University, Osaka, Japan

    Norimasa Nakamura

  6. Universidade Federal de São Paulo, São Paulo, Brazil

    Moises Cohen

  7. Sports Clinic, Centre Hospitalier de Luxembourg – Clinique d’Eich, Luxembourg City, Luxembourg

    Romain Seil

  8. Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science (LIROMS), Luxembourg City, Luxembourg

    Romain Seil

  9. Human Motion, Orthopaedics, Sports Medicine and Digital Methods (HOSD), Luxembourg Institute of Health, Strassen, Luxembourg

    Romain Seil

  10. Department of Orthopedic Surgery and Traumatology St. Marguerite Hospital, Institute for Movement and Locomotion (IML), Marseille, France

    Christophe Jacquet

Rights and permissions

Reprints and permissions

Copyright information

© 2024 Crown

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Olotu, O., El Meniawy, S., de SA, D. (2024). Tibial Spine Fractures. In: Espregueira-Mendes, J., Karlsson, J., Musahl, V., Ayeni, O.R. (eds) Orthopaedic Sports Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-65430-6_50-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-65430-6_50-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-65430-6

  • Online ISBN: 978-3-030-65430-6

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation