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 

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