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The purpose of this study was to report the long-term clinical outcome in a group of 14 patients treated for an avulsion fracture of the tibial spine. On the basis of the Meyers and McKeever classification, there were four type I avulsions, three type II and seven type III. Seven patients were treated nonoperatively and seven patients were operated according to one of the two different protocols: open reduction and internal fixation and arthroscopic reduction and internal fixation. At follow-up, four patients had clinical signs of joint instability, but no subjective instability. One patient with a type III lesion treated nonsurgically showed severe instability. All other patients returned to the same sport activity level that they had had before the fracture. We obtained good results in 13 out of 14 cases. Good results can be obtained when type I fractures are treated nonoperatively. Type II and type III lesions showed better results after arthroscopic reduction and internal fixation. Nonabsorbable suture fixation for osteosynthesis is recommended. The prognosis is strictly related to the type of fracture, anatomic reduction and articular congruity.