The tibial spine (intercondylar eminence) is the central bony prominence on the tibial plateau between the medial and lateral condylar articular surfaces. It consists of medial and lateral intercondylar tubercles separated by the intercondylar notch. The ACL inserts on the anterior intercondylar area (anterior to the medial tubercle) and the PCL on the posterior intercondylar area (behind the posterior aspect of the spine).
Tibial spine (tibial eminence) fractures are most common in children and adolescents, representing an avulsion of the ACL tibial attachment through the developing ossification centre rather than ACL mid-substance tear. The Meyers-McKeever classification (I-IV) grades displacement. Type I-II fractures may be treated closed with aspiration of haemarthrosis and knee extension immobilisation; Type III-IV displaced fractures require arthroscopic reduction and fixation (suture fixation through tibial tunnels or screw fixation). In adults, tibial spine avulsion from high-energy trauma is treated by ORIF.
Hyperextension or forced flexion knee injury in a skeletally immature child avulses the tibial spine with the ACL tibial attachment, producing haemarthrosis and positive Lachman test; arthroscopic reduction and suture fixation of displaced fragments (Meyers-McKeever III-IV) through tibial bone tunnels prevents long-term ACL instability from malunion.
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