Learning Radiology xray montage


Intercondylar Eminence Fracture
Anterior (Medial) Tibial Spine Avulsion Fracture


General Considerations

  • Also known as tibial eminence fractures or anterior cruciate ligament (ACL) avulsion fractures
  • Associated with anterior cruciate ligament injuries
  • Most common in children and frequently related to sports injuries or bicycle accidents; more often due to motor vehicle accidents in adults
  • The tibial eminence contains two spines, the more medial carrying the insertion of the broad attachment of the ACL
  • ACL attachment then fans out and coalesces with the attaching fibers of the anterior horn of the medial meniscus anteriorly and the anterior horn of the lateral meniscus posteriorly

Classification by Mayer and McKeevers




Nondisplaced fracture of tibial eminence; the avulsed fragment is not displaced from the fracture crater


Partially displaced fracture; anterior part of avulsed fragment is displaced superiorly


Completely displaced fracture involving only ACL insertion


Completely displaced fracture involving entire tibial eminence


Comminuted fracture of tibial spine


Clinical Findings

  • Knee pain
  • Inability to bear weight
  • Hemarthrosis

Imaging Findings

  • Frontal and lateral radiographs of the knee are usually obtained first
  • CT scan is helpful in assessing degree of comminution in adults but is usually not necessary in skeletally-immature patients
  • MRI shows associated ligamentous and cartilaginous injury


  • Anatomic reduction of fracture fragments
  • Re-establishing continuity of ACL
  • Treatment of Types II, III and IV may include open reduction and internal fixation, arthroscopic reduction and fixation


  • Excellent
  • Complications can include, laxity, arthrofibrosis or growth deformity in skeletally-immature patients


Intercondylar Eminence Fracture

Fracture of the Intercondylar Eminence. There is an avulsion fracture (red and white arrows) of the intercondylar eminence. There is a also a large suprapatellar hemarthrosis (yellow arrow). Such fractures are associated with injury to the anterior cruciate ligament.

Regional Arthroscopy. Tibial Spine Avulsion Fractures: Current Concepts and Technical Note on Arthroscopic Techniques Used in Management of These Injuries. Vikram Sapre and Vaibhav Bagaria. DOI: 10.5772/54967