Tibial Eminence Fracture

Description

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 ropelike structure that helps maintain the normal relationship of the thigh bone (femur) and the larger of the two bones of the lower leg (tibia). This ACL is most important in sports that require pivoting, changing direction rapidly, or jumping and landing. In children the bony attachment of the ACL is more likely to break off the tibia than the ligament is to tear (sprain). However, this ligament is often stretched in conjunction with the bone pulling off the tibia. This is because the bony attachment connects to the leg bone via growth plate cartilage, which is weaker than the ligament. Associated injuries to the collateral ligaments on either side of the knee or the meniscus cartilage occur often with this injury.

Common signs and symptoms

• A pop or tear heard or felt at the time of injury

• Significant knee swelling noticed almost immediately (within 3 hours)

• Inability to straighten the knee

• Pain around the knee

• Difficulty standing on the leg

• Knee gives way or buckles, particularly when trying to pivot, change direction rapidly, or jump; swelling with repeated giving way

• Locking (occasionally), when there is concurrent injury to the meniscus cartilage

Causes

A tibial eminence fracture is caused by a force that exceeds the strength of the growth plate. This injury may occur as a result of a noncontact injury, such as landing awkwardly or cutting while cleats are stuck to the ground, or from contact, such as getting tackled at the knee.

Factors that increase risk

• Sports that require pivoting, jumping, or rapid changes in direction (basketball, soccer, volleyball)

• Contact sports (football, rugby)

• Poor physical conditioning (strength, flexibility)

• Youth, especially athletes under 14 years of age

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