Osteochondral Autograft From the Proximal Tibiofibular Joint for Reconstruction of Acute Tibial Plateau Fractures With Severe Chondral Defects

Acute tibial plateau fractures with severe comminution and chondral defects including small free articular fragments and delaminated cartilage fragments can be challenging to reconstruct with open reduction and internal fixation. Alternative treatments include use of osteochondral allografts and total knee arthroplasty. Allografts are difficult to obtain in the acute setting, and total knee replacement is not ideal for young patients. There are limited options of acute reconstruction of the articular surface that can restore knee joint stability and restore a chondral surface for large tibial plateau articular defects. This report demonstrates a novel approach to reconstruction of acute tibial plateau fractures with severe articular defects with the use of an osteochondral autograft from the ipsilateral proximal tibiofibular joint. Two patients with closed acute tibial plateau fractures were treated with this technique to restore the lateral articular surface. The patients include a 37yo male with a Schatzker VI tibial plateau fracture and a 24yo female with a Schatzker II tibial plateau fracture. Both patients underwent open reduction and internal fixation with harvest of an osteochondral autograft from the tibial and fibular portions of the proximal tibiofibular joint through a standard lateral approach. The fibula head was left intact to preserve the attachment of the LCL. The 37yo male patient developed post-op arthrofibrosis with a knee flexion contracture. The contracture was managed with an open surgical release at 3 months with a posterior capsular release that included a knee arthroscopy that demonstrated healing of the lateral articular surface. The contracture completely resolved following the release and the patient was completely pain free in the affected knee at 12 months post-op. Both patients achieved bony union of the fracture and neither patient developed infection or complications other than the one case of arthrofibrosis. There are no prior case reports of the use the articular surface from the proximal tibiofibular joint in reconstruction of acute tibial plateau fractures. This technique provides a unique option for surgical management for fractures in young patients with severe articular comminution. The harvest of autograft from the proximal tibiofibular joint can be performed through a standard lateral approach to the tibial plateau with minimal morbidity for the patient.