[Treatment and evolution of chronic avulsion of the anterior tibial spine in the pediatric age].

Tibial spine avulsion fractures (also called tibial eminence fractures) are bony avulsions of the anterior cruciate ligament (ACL) from its insertion in the intercondylar eminence. It is most commonly seen in children aged eight to 12 years, because LCA is more resistent than bone and physis. Furthermore, the union between epiphisys and LCA is very strong due to the collagen fibers. Meyers and McKeever classification defines three types: type I: non displaced; type II: partially dislaced; and type III: completely displaced. This classification is very important for the treatment. Arthroscopic treatment is the gold standard for displaced fractures. The association with other intraarticular injuries is frequent, and the anterior horn of the medial meniscus or the transverse meniscal ligament is frequently trapped within the fracture site. A miniarthrotomy may still be necessary in fractures that are irreducible by arthroscopic means. Its difficult to find chronic fractures in children in the literature. The treatment is similar to acute cases, but includes debridement of the scar tissue and reparation of intraarticular injuries. Loss of extension is the main problem we find in this patients, although acceptable results may be achieved. In this article we present a seven years old boy with a chronic tibial spine avulsion, the treatment and the outcome.