Tibial Eminence Fracture: Radiology, Adults vs Pediatrics, Rehab Protocol, and Recovery Time

Tibial Eminence Fracture:

• What is Tibial Eminence Fracture?
• Radiology
• Adults vs Pediatrics
• Rehab Protocol
• Recovery Time

What is Tibial Eminence Fracture?

A Tibial Eminence Fracture—also known as an intercondylar eminence fracture or tibial spine fracture—is an injury that occurs when the bony prominence on the top of the tibia (where the anterior cruciate ligament, or ACL, attaches) is pulled away due to trauma. This type of injury is considered an equivalent of an ACL avulsion injury, as the ligament often remains intact but detaches the bone fragment instead.

Tibial eminence fractures commonly result from twisting injuries to the knee or sudden hyperextension, frequently seen in sports such as cycling, skiing, and football. The severity of the fracture can vary from mild displacement to complete avulsion. These fractures are classified into different types (Type I–IV) based on the degree of displacement and comminution, guiding treatment decisions from immobilization to surgical fixation.

Radiology

Radiological imaging plays a key role in diagnosing tibial eminence fractures. The first-line imaging modality is an X-ray of the knee, particularly anteroposterior and lateral views. On the lateral view, the fracture fragment can be seen as an elevated bone piece at the tibial plateau, often near the ACL insertion point. A skyline or oblique view may help identify subtle or minimally displaced fragments.

For more detailed evaluation, Magnetic Resonance Imaging (MRI) is often used. MRI provides a clear picture of the associated soft tissue injuries, including partial or complete ACL tears, meniscal damage, or cartilage involvement. CT scans may be helpful in preoperative planning, especially for complex or comminuted fractures. Radiology not only confirms diagnosis but also helps in fracture classification and guiding rehabilitation protocols.

Adults vs Pediatrics

Tibial eminence fractures in children are more common than in adults due to the relative weakness of the immature bone compared to the strength of the ligaments. In pediatric cases, the ACL often remains intact while the bony attachment is avulsed. Conversely, in adults, high-energy trauma tends to cause ligamentous injury rather than bone avulsion, leading to associated ACL tears rather than isolated fractures.

In children, non-operative treatment such as casting or bracing is often sufficient for non-displaced (Type I) or minimally displaced fractures. In contrast, adults or older adolescents with significant displacement (Type II–IV) typically require arthroscopic reduction and internal fixation to restore knee stability. Growth plate considerations are also important in pediatric cases to avoid long-term deformities or joint stiffness.

Rehab Protocol

The rehabilitation protocol following a tibial eminence fracture depends on the treatment type (conservative or surgical) and the degree of displacement. Initially, the focus is on immobilization to allow fracture healing while minimizing stiffness. In non-surgical cases, the knee is typically immobilized in extension for 4–6 weeks, followed by gradual range-of-motion exercises.

For surgical repairs, early controlled motion is encouraged after initial immobilization. The standard rehabilitation phases include:

• Phase 1 (0–2 weeks): Immobilization with partial or non-weight bearing, pain control, and edema reduction.
• Phase 2 (2–6 weeks): Gradual increase in knee flexion, quadriceps activation exercises, and gentle range of motion up to 90°.
• Phase 3 (6–12 weeks): Progress to full range of motion, strengthening, and balance training.
• Phase 4 (3–6 months): Return to sport-specific training and functional activities once radiologic healing is confirmed.

Close physiotherapy supervision is critical to avoid complications such as joint stiffness, loss of extension, or persistent instability.

Recovery Time

The recovery time for a tibial eminence fracture varies depending on the severity of the injury and the treatment approach. Non-displaced fractures treated conservatively usually heal within 8–10 weeks, with gradual return to normal activities. For surgically treated fractures, bone healing typically occurs within 3–4 months, though full return to sports may take up to 6–9 months.

Factors that influence recovery include patient age, degree of displacement, presence of soft tissue injuries, and adherence to rehabilitation protocols. Radiologic follow-up ensures proper healing and restoration of joint alignment. Long-term outcomes are generally excellent with early diagnosis and proper management, although residual laxity or stiffness may occur in a small number of cases.