Intercondylar tibial eminence fracture.

3D graphic representation of type I (nondisplaced), type II (hinged), and type III (completely displaced) tibial eminence fractures.

A low signal intensity line representing an avulsed cortical fragment (arrowheads) is demonstrated at the tibial eminence. A small portion of the adjacent non-ossified cartilage is also avulsed and is outlined by fluid. Intact ACL fibers (arrows) are inserting onto the fragment. The anterior margin of the fragment is mildly elevated, while the posterior portion of the fragment is nondisplaced, consistent with a hinged type fracture. Note that bone marrow edema at the fracture is minimal. A large joint effusion (asterisk) is present.

The lateral radiograph shows a thin linear density representing the avulsed tibial eminence fragment (arrowheads).

T1-weighted sagittal image of the knee of a 10 year-old boy with a type II fracture demonstrates elevation of the avulsed tibial eminence anteriorly (arrowheads). There is entrapment of a portion of Hoffa's fat pad (asterisk) underneath the fragment.

A comminuted, displaced tibial eminence fracture consistent with a type IV injury in an adult shown on a coronal T2-weighted image. The fragments (asterisks) are elevated and are no longer in contact with the underlying bone. Note that the anterior root of the lateral meniscus inserts onto one of the fragments (arrowhead), which could make fracture reduction more difficult. Concomitant injury includes a medial collateral ligament sprain (arrows).

A nondisplaced tibial eminence fracture (type I) (arrowheads) in an adult on a coronal fat-suppressed T2-weighted image. Other injuries include a Segond fracture (arrow), osteochondral injury of the lateral femoral condyle (asterisk), and a vertical longitudinal tear of the medial meniscus (not shown).

A T1-weighted sagittal image from an adult patient shows a large comminuted tibial eminence fracture with posterior extension. The tibial attachment sites of the anterior cruciate ligament(arrowhead), the posterior cruciate ligament (asterisk), the posterior roots of both menisci (not shown), and the anterior root of the lateral meniscus (not shown) are involved.

Tibial intercondylar eminence fractures are most common in children and teenagers but do also occur In adults. Staging and initial management are based on the modified version of the Meyers and McKeever classification using radiographs. MRI is extremely useful in the workup and management of these fractures because of the high incidence of concomitant injuries to the menisci, ligaments and cartilage. MRI can depict features that will prevent closed reduction, such as soft tissue entrapment underneath the fracture fragment, and involvement of the insertion site of the anterior horn of the lateral meniscus.