Tibial spine (eminence) fractures are often referred to as the pediatric equivalent of an adult anterior cruciate ligament (ACL) tear. They occur predominantly in the pediatric population owing to the relative weakness of their ligaments and incomplete ossification of epiphyseal bone. Historically, these fractures were caused mostly by bicycle accidents, but more recently are mainly because of sporting activities. Diagnosis is made with a combination of the patient’s history, physical exam, and often confirmed with a radiographic image. These fractures are classified using the Meyers and McKeever system, which is based on the radiographic appearance of the fracture and degree of displacement. Surgical and nonoperative treatments exist for these fractures depending on the presentation and severity of the injury. Persistent laxity, loss of range of motion, and arthrofibrosis can be seen after treatment. However, long-term outcomes of treatment are favorable, regardless of treatment option.