Tibial eminence fractures (TEFs) are common in pediatric patients, accounting for approximately 2-5% of all pediatric knee injuries.1,2 These fractures typically occur between the ages of 8-14 years old due to relative weakness of pediatric subchondral epiphyseal bone.3,4 Fracture of the tibial eminence is considered functionally equivalent to a rupture of the anterior cruciate ligament (ACL), in which the incomplete ossification of the tibial eminence causes the bone to fail rather than the ligament.5 Surgical fixation of displaced TEFs is thus indicated to restore stability to the knee.

Current treatment recommendations include surgical fixation for displaced TEFs followed by early rehabilitation. Various technique options have been described for fixation of TEF's. Pediatric bone has different biomechanical properties than adult human bone, which may influence the success of various TEF fixation methods.6, 7, 8 Two of the most popular techniques involve arthroscopically-assisted reduction with either screw or suture fixation. A recent study suggested that suture fixation is equivalent to screw fixation in terms of biomechanical properties when the fixation methods were tested in human pediatric knees.9 A recent meta-analysis comparing repair using one screw versus repair with one high-tensile strength suture suggests that single high-tensile strength suture fixation may be biomechanically superior to single screw fixation.10 Another recent study found no difference between 2-screw and 2-suture fixation for TEFs.11

Amidst all the evidence, it appears that the two fixation methods have similar biomechanics and clinical outcomes with a slight trend towards suture fixation over screw fixation of TEFs. Screw fixation provides a direct reduction of the TEF while suture fixation tensions the ACL itself with an indirect reduction of the fracture. Screw fixation may not be possible with thin bony or chondral fragments or with comminution of the fracture fragment. The senior author prefers suture fixation for the treatment of TEFs due to the versatility of the operative technique.