Tibial Eminence: Anatomy, Fracture, Avulsion, Treatment & Rehab Protocol

Tibial Eminence:

• What is Tibial Eminence?
• Anatomy
• Fracture
• Avulsion
• Treatment
• Rehab Protocol

What is Tibial Eminence?

The tibial eminence, also called the intercondylar eminence, is a bony structure located on the upper surface of the tibia between the medial and lateral tibial plateaus. It serves as a critical attachment point for the anterior cruciate ligament (ACL), which stabilizes the knee joint by preventing anterior translation of the tibia relative to the femur.

This structure is particularly important in orthopedic and sports medicine because injuries to the tibial eminence often involve ACL function. Fractures or avulsions in this area can compromise knee stability and significantly affect mobility, especially in children and young adults where these injuries are more common due to sports trauma.

Anatomy

The tibial eminence consists of two small bony ridges: the medial intercondylar tubercle and the lateral intercondylar tubercle. Together, they form the intercondylar eminence. The ACL inserts into the anterior portion of this eminence, while the posterior cruciate ligament (PCL) inserts just behind it.

Surrounded by the smooth articular surfaces of the medial and lateral condyles of the femur, the eminence is integral to knee joint biomechanics. Its location within the intercondylar region makes it susceptible to injury during forced twisting, hyperextension, or high-impact sports injuries. In children, it is more prone to fracture than the ACL itself, because the ligament is often stronger than the bony insertion.

Fracture

A tibial eminence fracture is typically caused by trauma, such as a fall, motor vehicle accident, or sports injury involving rapid deceleration and twisting. It is essentially an avulsion-type injury where the ACL pulls off a fragment of bone from its tibial attachment site. These fractures are most common in children and adolescents aged 8–14 years.

Clinically, patients may present with knee swelling, pain, difficulty bearing weight, and restricted range of motion. X-rays or MRI scans are used for diagnosis. Meyers and McKeever classification is often used to grade tibial eminence fractures, ranging from nondisplaced (Type I) to completely displaced (Type III). Proper classification guides treatment planning.

Avulsion

A tibial eminence avulsion refers specifically to the detachment of the bony fragment at the ACL attachment site. Unlike ligament tears, avulsion injuries often spare the ACL fibers but compromise their attachment to bone, leading to instability.

Avulsions are frequently seen in children because their bone is not fully developed and is weaker compared to the ligament. In adults, high-energy trauma is usually required for such injuries. If left untreated, tibial eminence avulsion can lead to chronic ACL laxity, instability, and long-term joint degeneration.

Treatment

Treatment depends on the severity of the fracture or avulsion. Nondisplaced (Type I) fractures are usually managed conservatively with immobilization in a cast or brace for 4–6 weeks. Type II fractures may require closed reduction followed by immobilization. Displaced (Type III) and comminuted fractures often require surgical fixation using screws, sutures, or arthroscopic techniques to restore joint stability.

Post-treatment care involves pain management, regular imaging follow-up, and prevention of stiffness with early mobilization when safe. Failure to properly treat tibial eminence injuries can lead to persistent instability, loss of range of motion, and higher risk of osteoarthritis.

Rehab Protocol

Rehabilitation after a tibial eminence fracture or avulsion is crucial for regaining knee function. Initially, immobilization is followed by gradual range-of-motion exercises once healing is confirmed radiologically. Weight-bearing is typically delayed until adequate healing is seen.

Rehab progresses from passive and active-assisted movements to strengthening of the quadriceps, hamstrings, and hip stabilizers. Balance training and proprioception exercises are added gradually. Full return to sports may take 4–6 months depending on severity and treatment type. Close supervision by an orthopedic specialist and physiotherapist ensures safe recovery and reduces the risk of re-injury or ACL insufficiency.