Tibial Eminence Fractures (Pediatric)
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What are tibial eminence fractures?
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, recent research has identified that higher velocity injuries are associated with midsubtance ACL tears and slower loading mechanisms cause injuries at the tibial eminence.
A thorough examination of the knee is required as a tibial eminence fracture is associated with other injuries to structures in the knee including the meniscus, cartilage and ligaments.
Who is at risk of tibial eminence fractures?
This condition is most commonly seen in children ages 8 to 14 years old.
How are tibial eminence fractures diagnosed?
Our doctors start by taking your child's medical history and doing a physical examination similar to the type done for ACL ruptures. Next we order a series of knee X-rays to look for fractures. In some cases, we do an MRI to evaluate for additional injuries and confirm if any structures (such as the meniscus or meniscal ligament) are stuck in 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 severity:
- For a minimally displaced fracture, treatment may simply be 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, our preference is to fix the tibial eminence fracture with arthroscopic techniques.
Recent studies highlight a high rate of knee stiffness, known as arthrofibrosis, in children with tibial eminence fractures. At the Adolescent and Pediatric Center of New York, 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.