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Tibial Spine Avulsion


A tibial spine avulsion is an injury to the area where the anterior cruciate ligament (ACL) attaches to the tibia (shin bone). Instead of tearing the ligament, the bony area where the ACL attaches gets pulled away from the rest of the bone.

The best way to explain this is to compare it to an uprooted tree.

Instead of the failure point occurring in the middle of the tree trunk (i.e. the ligament), the tree’s root system (i.e. the bony attachment) gets pulled out of the ground.

With a tibial spine avulsion, the area of bone that is attached to the ACL gets pulled away from the rest of the bone. In our experience, this injury occurs in two age groups: preadolescent (age 9-14) and adult.

Common signs/symptoms

  • Stiffness including inability to fully extend knee/leg
  • Swelling
  • Pain in the joint
  • Difficulty walking


Our treatment approach to this problem is unique. We value the importance of restoring normal range of motion to the knee following this injury. We have found that attempting to re-attach the elevated piece of bone causes limitations in range of motion and function. Therefore, our surgical technique involves removing the elevated piece of bone, leaving the ACL fibers to heal to intact ACL. Our research shows that patients treated with this technique achieve excellent stability and range of motion.

The goal of treatment for a tibial spine avulsion injury is to regain full, symmetric range of motion and stability. The elevated piece of bone limits extension (straightening) motion. Sometimes this piece of bone can be put back into place by working on range of motion under the guidance of a medical professional. Other times, the piece of bone needs to be removed by doing an arthroscopy. Many times this is all that needs to be done to treat this problem. However, if patients have feelings of instability, an ACL reconstruction may be needed. The doctors at the Shelbourne Knee Center will discuss your options with you during your evaluation.