Tibial spine fractures: State of the art.

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Abstract

[Indexed for MEDLINE] 2. J Orthop Surg Res. 2026 Mar 18;21(1):278. doi: 10.1186/s13018-026-06797-1. Management of type II tibial spine fractures in children and adolescents: a systematic review. Sapienza M(1), Torrisi P(2), Mirto F(2), Amico M(2), Russo A(3)(4), Costa GG(3)(4), Raciti F(2), Testa G(2), Pavone V(2). Author information: (1)Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico-San Marco, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy. marcosapienza09@yahoo.it. (2)Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico-San Marco, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy. (3)Faculty of Medicine and Surgery, Kore University of Enna, 94100, Enna, Italy. (4)Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale Di Enna, 94100, Enna, Italy. BACKGROUND: Tibial spine avulsion fractures (TSFs) are the pediatric equivalent of anterior cruciate ligament (ACL) injuries. The optimal management of type II fractures remains debated, and both conservative and surgical strategies have been described. This systematic review compares outcomes of nonsurgical and surgical treatments in type II TSFs and evaluates different surgical fixation techniques. METHODS: A PRISMA-guided search identified studies reporting clinical and radiographic outcomes of pediatric TSFs. Data were pooled for patient demographics, treatment, complications, and functional results. Comparative analyses were performed for conservative versus surgical management in type II fractures and for suture versus screw fixation across all surgical cases. RESULTS: Thirty-eight studies (1,070 patients) were included. In type II fractures (371 knees), surgical treatment achieved lower rates of clinical instability (0.7% vs. 13.2%, p