Fractures of the tibial spine have been classified by Meyers and McKeever. Type three fractures are completely displaced and multiple methods have been employed to treat this injury. We report an arthroscopic technique, using the Accufex ACL tibial drill guide, which has been used successfully to manage this complicated problem. Advantages of this technique include: no morbidity from an arthrotomy, ability to diagnose and treat concomitant injuries, anatomic reduction of the fragment, no retained hardware, and limited surgical time.