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.