A tibial eminence fracture is a partial or complete fracture of the attachment of the anterior cruciate ligament (ACL), one of the four major ligaments of the knee. The ACL is a rope-like structure that helps maintain the normal relationship between the femur (thigh bone) and tibia (leg bone).
In young children, the bony attachment of the ACL is more likely to fracture than the ligament is to tear or sprain. The ACL may also be stretched along with the bone pulling away from the tibia.
What Is a Tibial Eminence Fracture?
A tibial eminence fracture is a partial or complete fracture of the bony attachment of the ACL. The ACL is especially important during activities that involve pivoting, changing direction, jumping, and landing.
Treatment focuses on reducing the fracture and restoring the connection and function of the attached ACL.
Causes and Risk Factors
A tibial eminence fracture occurs when a force exceeds the strength of the bone. The injury may occur without contact, such as landing awkwardly or cutting while cleats are stuck in the ground, or from contact, such as being tackled at the knee.
Risk factors include:
- Sports that require pivoting, jumping, cutting, or changing direction, including basketball, soccer, and volleyball
- Contact sports, including football and rugby
- Poor physical conditioning, including strength and flexibility
- Athletes under 14 years of age
- Improper equipment, such as long cleats
Symptoms
Common signs and symptoms include:
- A pop or tear heard or felt at the time of injury
- Large knee swelling that develops almost immediately, usually within three hours
- Inability to straighten the knee
- Pain around the knee and difficulty standing on the leg
- The knee giving way or buckling, particularly when pivoting, cutting, or jumping
- Swelling associated with repeated episodes of the knee giving way
- Occasionally, locking when there is also an injury to the meniscus cartilage
Treatment
Initial treatment consists of medications and ice to relieve pain and reduce knee swelling.
If the fractured bone fragment is in the proper position, or can be positioned without surgery, immobilization with a brace or cast for four to six weeks is recommended. Crutches may also be recommended for walking.
If the bones are not in the proper position, surgery is usually needed to reposition the fracture and hold it with sutures, wires, or screws. The sutures, wires, or screws usually do not need to be removed.
After immobilization, with or without surgery, stretching and strengthening of the injured and weakened joint and surrounding muscles are necessary. Physical therapy may be used, with or without the assistance of a physical therapist or athletic trainer.
Recovery and Outcomes
The bone will usually heal, although some knee looseness and giving way may remain, especially during sports that require pivoting, cutting, jumping, and landing.
Potential complications include:
- Failure to heal (nonunion)
- Healing in a poor position (malunion)
- Frequent recurrence of symptoms, including knee giving way, instability, and swelling
- Injury to the meniscal cartilage, which may result in locking and swelling of the knee
- Injury to other knee structures, including the articular cartilage, which may result in arthritis of the knee
- Injury to other knee ligaments
- Knee stiffness
- Risks of surgery, including infection, bleeding, injury to nerves resulting in numbness, weakness, or paralysis, and the need for further surgery, including ACL reconstruction
When to See Dr. Chudik
Schedule an evaluation after any significant knee injury with inability to bear weight, severe swelling, or concern for fracture. Call 630-324-0402 or request an appointment online.