The aim of this study was to describe our experiences with arthroscopy-guided intra-articular button fixation in the treatment of displaced tibial eminence fractures in skeletally immature children. Eleven adolescent patients with an average age of 12.2 years were treated arthroscopically between January 2005 and February 2007. At follow-up evaluation at 69 months, we did not find any instability. Only minimal differences were found in the functional outcomes (Lysholm and International Knee Documentation Committee scores: 95.7 and 94.3, respectively). None of the patients had a leg-length discrepancy defined at the time of the final follow-up. The advantages of this technique are as follows: (a) it is a simple and reliable arthroscopic technique with a direct view, (b) the fixation is stable, (c) there is no need to remove the implant, (d) minimal physeal interruption in a pediatric skeletally immature population, and (e) no additional arthroscopic portal.