The medial collateral ligament (MCL) is a major stabilizer of the knee joint. It is the most common ligament injured in the knee, particularly in athletes, and has been reported to be torn in 7.9% of all knee injuries. The MCL has a complex, layered anatomy with multiple insertions and functions. Minor trauma can cause tearing of the superficial portion whereas higher energy mechanisms can disrupt both the deep and superficial layers. History and physical are often adequate, but the gold standard for diagnosis is MRI. Lesser injuries to the MCL can often be treated conservatively with early rehabilitation, but more significant tears often necessitate surgery. A thorough understanding of the MCL and associated injuries is essential for proper diagnosis and treatment.

Fractures about the tibial tubercle are uncommon fracture patterns, seen most often in adolescent males as they approach skeletal maturity. Compartment syndrome has a high association with these fractures requiring close monitoring, and a heightened level of suspicion. Tibial tubercle fractures are typically stratified using the Ogden classification. The type of intra-articular involvement and degree of displacement guide appropriate treatment. This report highlights a 14-year-old male patient who suffered a type IV tibial tubercle fracture with a unique Salter–Harris II, or transitional, component posteriorly that was unable to be closed reduced and developed compartment syndrome. He underwent fasciotomy, open reduction, and temporary external fixation. Once the status of the soft tissues improved, he underwent staged open reduction and internal fixation with skin grafting. The patient’s fracture and soft tissues healed and he currently ambulates without assistance or pain, and has returned to all desired activities including competitive sports.