Many questions arise when dealing with tibial spine injuries. Is anatomic fracture reduction necessary to avoid the need for later ACL reconstruction? What is the optimal fixation device? Can these fractures be treated through an arthroscopic approach effectively? Does age influence decision making and clinical results? Will early postoperative range of motion (ROM) decrease the risk of arthrofibrosis, which has been noted in previous studies on tibial spine fractures? The main goal of surgical treatment is to heal the displaced part in its anatomical position. Thus, it is aimed to prevent the possible knee joint instability and extension limitation. Screw fixation is an effective and safe surgical option with few complications. Screws can be inserted either retrograde or anterograde. Anterograde insertion is achieved with an aiming guide placed superoanterior to the inferoposterior direction with the knee at 900 of flexion. Retrograde screws are inserted from the anterior cortex of the proximal tibial through the tibial eminence fracture. The screw technique is simple, reproducible, and good fracture repair with almost immediate weight bearing postoperatively, on the other hand there are a few limitations to screw fixation. Cannulated screws may cause anterior impingement, fretting between the washer and screw, and damage of the articular surface, leading to a higher rate of implant removal. Another limitation is the ineffective fixation of small or comminuted fragments where insertion can lead to further comminution or displacement. In skeletally immature patients, growth disturbance and leg length discrepancy may occur as a result of screw damage to the physes.