What is the sequence of tibial growth plate closure?

• A. Central, anteromedial, posteromedial, lateral
• B. Lateral, central, anteromedial, posteromedial
• C. Central, posterior, anteromedial, lateral
• D. Central, lateral, anteromedial, posteromedial

Answer: (A)

Growth plate closure in the tibia happens progressively from the center outward, so the order of maturation follows a center-to-periphery pattern. In adolescents, the central portion of the physis closes first, then the anteromedial portion, followed by the posteromedial portion, with the lateral portion closing last. This sequence—central first, then anteromedial, then posteromedial, then lateral—best fits the way the physis ossifies as skeletal maturity approaches.

Understanding this helps when reading pediatric knee or leg radiographs to assess remaining growth potential and anticipate physeal arrest after injury. Sequences that place the lateral or posterior regions before the anteromedial region don’t match the typical maturation pattern and aren’t consistent with how the tibial physis tends to close.