 Tibial spine fractures account for 5% of all knee injuries in children and adolescents. Considered equivalent to ACL ruptures in adults, tibial spine fractures involve an evolution of the tibial spine, which in growing children tends to be weaker than the ACL. While there is some debate as to whether fixation with screws or sutures is better, no previous study has compared the two techniques in pediatric cadaveric specimens. Reporting in the American Journal of Sports Medicine, researchers compared screw and suture fixation using 12 pediatric cadaveric knees matched for age and laterality. Knees assigned to screw fixation were repaired by placing two wire-guided screws into the medial and lateral borders of the tibial spine fracture and fracture bed at 45-degree angles. In the suture fixation group, a suture was passed through the anterior one-third and posterior one-third of the ACL. The fixation techniques were tested under cyclic loading by comparing three main biomechanical properties, ultimate failure, stiffness, and elongation. According to the results, screw fixation demonstrated increased stiffness and decreased elongation. Overall, however, the results for the two groups were not significantly different, indicating that biomechanically, suture and screw fixation were comparable in repairing tibial spine fractures in pediatric cadaveric knees. Despite being the only study to examine pediatric tissue, specimens above the age of 10 were not tested. Therefore, the study was limited to the less-skeletally mature portion of the age range of patients at highest risk of tibial spine fractures. In addition, testing was only performed along a single direction without rotation. Therefore, the results do not provide a full picture of fixation behavior. Nevertheless, one potentially promising finding is that the failure loads measured in this study were lower than those reported in porcine and adult tissue. Therefore, while it's currently unclear whether screw or suture fixation is better for children and adolescents with tibial spine fractures, the use of pediatric cadaveric knees may offer a more realistic depiction of injury.