Knee conditions

Tibial Spine Fractures

Also called a tibial eminence fracture — the childhood equivalent of an ACL tear.

In an adult, a twisting injury usually tears the ACL in its middle. In a child, the ligament often holds and the piece of bone it attaches to — the tibial spine, or tibial eminence — pulls away from the top of the shin instead. It is one of the injuries Dr. Green’s research has concentrated on.

A young soccer player being helped up during a match

Why this happens to children and not adults

The bone at a child’s ACL attachment is still developing, and in a young skeleton it is often the weakest point in the chain. So the same movement that tears an adult’s ACL can instead detach a fragment of bone in a child.

How the fragment sits — whether it is undisplaced, lifted, or fully displaced — is what guides treatment, which is why the imaging review matters.

How Dr. Green decides between surgery and non-surgical treatment

How Dr. Green treats a tibial spine fracture

Fixation of the displaced fragmentSecuring the bony fragment back to its bed at the top of the tibia.
Arthroscopic techniqueDr. Green has published on tibial spine fracture fixation technique in the pediatric knee.

15 peer-reviewed papers on tibial spine fractures

Dr. Green's published research on tibial spine fractures

Of the papers indexed on PubMed under Dr. Green’s Hospital for Special Surgery affiliation, 15 are on this subject.

See the full publication record

Dr. Green wrote HSS’s clinical article on this condition

Tibial Spine Fractures of the Knee in Children appears in the HSS health library with Gabrielle P. Konin, MD. He is the first of 2 authors. It was published on 2024-02-22. The article is HSS’s, and it is published there rather than reproduced here.

Read it on hss.edu

In Dr. Green’s own words

Determining which patients with tibial spine fractures need to have surgery has been problematic with the standard classification system. But surgery is important in reducing the risk of scar tissue, which affects 10% to 20% of kids with this injury.

We hope our findings help more surgeons become aware of arthrofibrosis risk in patients with tibial spine fractures so that patients may receive specialized care when appropriate.

— Dr. Daniel W. Green, in Tibial Spine Fractures of the Knee in Children, Hospital for Special Surgery

The papers themselves

The 8 most recent of his 15 papers on this subject, indexed on PubMed under his Hospital for Special Surgery affiliation. Each opens on PubMed.

All 15 of his papers on this subject

Questions parents ask

Is a tibial spine fracture the same as an ACL tear?

They are the same mechanism with a different result. The ACL itself is usually intact — it is the bone at its attachment that has come away.

Why is it also called a tibial eminence fracture?

The two names describe the same injury; "tibial eminence" is the other common term for that bony prominence at the top of the shin.