COPYRIGHT © 2003 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED Long-Term Follow-up of Fresh Tibial Osteochondral Allografts for Failed

management of large posttraumatic full-thickness osteochondral defects in the proximal part of the tibia remains a challenge. The goal of treatment is a pain-free range of motion of the knee that provides enduring function and enables a young patient to participate in a wide range of activities. The use of fresh osteochondral al-lograft transplantation for tibial plateau lesions has been well documented. The purpose of the present study was to assess the survivorship and the long-term functional outcome following fresh osteochondral transplantation for uni-polar posttraumatic tibial plateau defects in young, high-demand patients. Methods: A cohort study was carried out to assess outcome in patients who had undergone fresh tibial osteochon-dral grafting for the treatment of a posttraumatic defect that measured at least 3 cm in diameter and 1 cm in depth. Sixty-five (97%) of sixty-seven patients were identified and were evaluated clinically and radiographically. A modified Hospital for Special Surgery (HSS) score was calculated for each patient. Radiographic examination was directed to-ward the identification of graft union, resorption, or collapse. Degeneration of the joint and alignment of the limb (on standing radiographs) was assessed. The end points that defined survivorship were an HSS score of <70 points, a patient’s decision to undergo knee arthroplasty, or revision of the graft for any reason. Results: At a mean of twelve years, forty-four patients had an intact graft and twenty-one had had conversion to a to-tal knee arthroplasty. The mean modified HSS Score for the patients with an intact graft was 85 points. Radiographs