TIBIAL SPINE AVULSION                                   KANDIL NOTES

INTRODUCTION

  • A tibial spine avulsion is an injury to the bony insertion of the ACL in the tibia, the pediatric equivalent of an ACL tear

  • The Anterior cruciate ligament (ACL) is one of the major knee ligaments providing stability to the knee

  • The primary function of the ACL is to prevent the leg bone from moving forward relative to the thigh bone. 

  • Injury to the tibial spine can lead to knee instability and buckling, which is associated with pain, swelling and apprehension

  • Grading system of tibial spine avulsions: 

  • Type 1: Non-displaced

  • Type 2: Minimally displaced with intact bony hinge posteriorly

  • Type 3: Completely displaced

  • 5% of pediatric knee injuries with swelling are tibial spine avulsions

  • 40% of tibial spine avulsions also have a meniscus tear

CAUSES

  • Tibial spine avulsions usually occur after noncontact twisting injuries during sports

  • They usually occur when the foot is planted on the ground and a bending force is applied to the knee, causing the tibial spine avulsion to occur

SIGNS AND SYMPTOMS

  • Tibial spine avulsions are almost always associated with immediate pain and swelling

  • Patients oftentimes hear or feel a “pop” in their knee

  • Instability of the knee, such as giving out and buckling, is common after tibial spine avulsions

TREATMENT​​

  • Treatment of tibial spine avulsions depends on grade

  • Type 1 injuries are treated with casting

  • Type 2 injuries are treated with closed reduction and casting

  • Type 3 injuries are usually treated with surgical repair arthroscopically via screw repair or suture fixation

 PREVENTION

  • The best way to prevent a tibial spine avulsion is to work on strengthening hamstrings and learning proper landing mechanics 

Tibial spinal avulsion capture 1.png