The cartilage of the tibiofibular joint: a source for autologous osteochondral grafts without damaging weight-bearing joint surfaces.

Within the past few years, autologous osteochondral transplantation has become an established procedure in the therapy of articular cartilage defects of the knee. One significant disadvantage of this technique is the harvesting of grafts from the weight-bearing area. The tibiofibular articulation is less loaded. The purpose of this study was to evaluate the question of whether this joint is suitable as a donor site for osteochondral grafts. Ten fresh human knees were dissected to perform histology, immunohistochemistry, and thickness measurement of the tibiofibular cartilage. Favourable approaches and establishing of anatomical landmarks were investigated in 44 fixed tibiofibular joints. In knee extension, the shortest distance between the joint cleft and common fibular nerve was measured. A total of 389 bone specimens was analysed morphometrically (cartilage area, orientation of the joint line, signs of arthrosis). Histological and immunohistochemical examination showed hyaline cartilage and type II collagen. The area of cartilage amounted to 3.58 cm(2) (mean) at the tibia and at the fibula with a thickness of 1.6 mm (mean). The joint line is mainly orientated perpendicular to an axis course from craniomedioventral to caudolaterodorsal. Depending on the available instruments, two approaches are possible: from anteromedial or from posterolateral. The mean distance to the common fibular nerve was 19.5 mm. Signs of arthrosis were found in 1 of 10 fresh knee specimens and in 11.4% of the bone specimens. Transplantation into three patients showed no intra- or postoperative complications and a rapid and uneventful recovery. The proximal tibiofibular joint is an excellent donor site for autologous osteochondral grafts.