The tibial spine is an area at the top of the shinbone (tibia). In adults, the tibial spine is hardened bone, but in kids who haven't finished growing, it's soft and more prone to injury.

Tibial spine avulsion happens when the anterior cruciate ligament (ACL) pulls a small piece of bone away from the top of the shinbone. 

Kids with a tibial spine avulsion usually have pain and a swollen knee that they can't completely bend. Tibial spine avulsion is treated by an orthopedic (bone) specialist. Treatment includes a cast or surgery, followed by physical therapy.

If a cast was put on your child's knee, follow the orthopedic specialist's instructions for:

• Using crutches.
• Going to see a physical therapist.
• Giving your child acetaminophen (Tylenol^® or a store brand) or ibuprofen (Advil^®, Motrin^®, or a store brand) for pain. Follow the package directions for how much to give and how often.
• Treating swelling:
  • Put ice wrapped in a towel on the cast for 20 minutes a few times a day.
  • Raise the leg above the level of the heart.
• When to follow up.
• What activities your child should avoid.
• Cast care:
  • Keep the cast dry. No swimming and cover the cast with 2 plastic bags or a cast cover for baths.
  • Put tape or moleskin on the edge of the cast if the edge is scratching the skin.
  • Keep dirt, sand, lotion, and powder away from the cast.
  • For itching, tap lightly on the cast or use a hair dryer on the cool setting to blow air in and around the edges.
  • Raise the leg above the level of the heart for 1 hour if the toes are swollen. If the swelling doesn't get better, call the orthopedic specialist.

If your child will have surgery, follow the orthopedic specialist's instructions for:

• Wearing the knee brace or immobilizer.
• Using crutches.
• Scheduling surgery.
• Giving your child acetaminophen (Tylenol^® or a store brand) or ibuprofen (Advil^®, Motrin^®, or a store brand) for pain. Follow the package directions for how much to give and how often.
• Treating swelling:
  • Put ice wrapped in a towel on the knee for 20 minutes a few times a day.
  • Raise the leg above the level of the heart. If the swelling doesn't get better, call the orthopedic specialist.
  • Wrap the knee in an elastic bandage. It should be snug, but you should be able to fit two fingers under it.

Your child:

• Has pain that gets worse
• Has swollen toes even after raising the leg for 1 hour
• Has red or raw skin around the cast, knee brace, or knee immobilizer
• Feels their cast is too tight; or the cast is cracked or loose, gets wet, or smells bad

• Your child can't wiggle their toes.
• Your child has severe pain when moving the toes.
• The foot or toes are pale or blue.

What causes tibial spine avulsions? They can happen in kids who play sports — for example, from a football tackle, a quick stop, or a fall. They also can happen if the knee gets twisted or is hit directly (such as in a bike accident or car crash).

How long does it take for a tibial spine avulsion to heal? It depends on how severe the break was and how it is treated. If the injury is treated with a cast, the cast usually stays on for about 6 weeks. After the cast comes off, kids need physical therapy for about a month to get their strength and flexibility back. After that, they usually can go back to sports and full activities. Healing takes longer if surgery was needed.