Late osteochondral allograft resurfacing for tibial plateau fractures.

Seventeen patients in whom secondary degenerative arthritis developed after a tibial plateau fracture underwent osteochondral allograft resurfacing of the involved plateau. The transplantation was done within twenty-four hours of procurement of the allograft from a cadaver donor so that viable cartilage would be used. There were sixteen tibial resurfacing grafts, and one patient had a tibial and femoral graft. Twelve patients have been followed for more than two years. A rating system for pain and function showed marked improvement in ten of the twelve patients. The clinical results were not related to age, interval from injury to grafting, type of graft, length of follow-up, or radiographic data. We believe that appropriate selection of patients for the procedure was the factor that led to the best results. Collapse of the osseous portion of the graft measuring more than three millimeters occurred in two patients, and there was obliteration of the cartilaginous joint space in one patient. This method of joint resurfacing requires minimum resection of tissue and avoids the use of a prosthesis. The ultimate fate of these grafts is not known, but the results in our series were encouraging. however, at this time the procedure should be restricted to younger patients with disabling, localized post-traumatic arthritis.