The Pediatric ACL: Tibial Spine Fracture

Pediatric tibial spine fractures are historically considered to be the equivalent injury of a skeletally mature anterior cruciate ligament rupture. Although not a valid belief, the fracture type is indeed an important variation of the anterior cruciate ligament tear that needs to be considered in its own right. Evaluation of the fractures by examination and radiographic assessment are important in determining the appropriate treatment. Some of these fractures can be treated without surgical intervention, but the complications of meniscus entrapment and anterior cruciate ligament laxity need to be considered. When management is surgical, then the fixation of the fragment can be adjusted to match the need and surgeon experience; and the risks of surgery include the standard issues of infection, but also an increased risk of arthrofibrosis. Outcomes for these injuries are generally good, with most children achieving return to full activity. Yet, injury to the anterior cruciate ligament in conjunction with the tibial spine avulsion may result in long-term laxity issues with an unknown consequence to risk for formal anterior cruciate ligament rupture.