Type III fractures of the tibial spine require open reduction and internal fixation when conservative treatment fails. The Acutrak cannulated screw system has been used successfully for arthroscopic reduction and fixation of these injuries. It was used in four children and two adults; all patients have returned to their preinjury exercise status. The use of a tent peg technique in children allows preservation of the proximal tibial physis, which prevents premature epiphysiodesis.