The tibial spine is located at the top front area of the shinbone (tibia) near the knee. In adults, the tibial spine is hardened bone, but in kids who haven't finished growing, it's soft and more prone to injury. Your child had a tibial spine avulsion. This happens when the anterior cruciate ligament (ACL) pulls a small piece of bone away from the top of the shinbone. 

The orthopedic surgeon put the broken part of the bone back in place. Over the next few weeks, your child will need to wear a knee immobilizer or brace while the bone heals.

Your child needs to rest the knee so that it can heal. They will need physical therapy to strengthen the knee and improve motion. After the orthopedic specialist and physical therapist say it's OK, your child can go back to full activities and sports.

Follow your surgeon's recommendations for:

• changing the dressings. These usually are held in place by an elastic bandage.
• giving any pain medicine. This may include prescription pain medicine, acetaminophen (Tylenol^® or a store brand), or ibuprofen (Advil^®, Motrin^®, or a store brand). Some prescription pain medicines also include acetaminophen or ibuprofen. To avoid giving too much, give the medicines exactly as your health care provider recommends.
• using crutches
• wearing the knee immobilizer or brace (including during sleep)
• when it's OK to put weight on the knee
• any exercises your child should do and any activities to avoid
• bathing (usually after 3 days)

To help with swelling:

• put ice wrapped in a towel on the knee for 20 minutes a few times a day (or more often if the surgeon recommends it) 
• raise the knee above the level of the heart 
• loosen the elastic bandages or the knee brace/immobilizer

Your child has:

• not peed by the evening on the day of the surgery
• pain that isn't controlled by the medicines or that gets worse 
• swelling that's not helped by raising the leg and loosening the elastic bandage and knee brace or immobilizer for 1 hour
• a lot of fluid or blood draining from the surgical site
• a fever

• The knee or lower leg gets very swollen.
• Your child has chest pain or is short of breath.

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 healing take after surgery for tibial spine avulsion? By working with their orthopedic surgeon and physical therapist, most kids can be back to sports and all activities about 6 months after surgery.