Chronic degenerative changes in the knee secondary to traumatic injury result in progressive osteoarthritis, substantial pain, and disability. The pathogenesis occurs when the bony architecture supporting the meniscus is altered, leading to changes in joint kinematics. This results in decreased areas of force dissipation, increased point loading, varus and/or valgus laxity, joint instability, and early cartilage degeneration. This can predispose young, active patients to substantial functional impairments, decreased activity levels, and early arthroplasty with a high likelihood for revision surgery. Unfortunately, no single treatment option exists for these patients. Hemi-tibial plateau allograft transplantation has been described as a potential surgical treatment option to prevent rapid progression of osteoarthritis and delay arthroplasty; however, the procedure requires considerable skill and anatomic considerations. In patients with malalignment or uneven distribution over the graft site, transplantation with concurrent proximal realignment may be a good treatment option.

This video demonstrates hemi-tibial plateau allograft transplantation with concurrent distal femoral varus osteotomy for management of a chronic, depressed lateral tibial plateau fracture with meniscal loss. The video provides an overview of the pathogenesis, diagnosis, and management of chronic tibial plateau fractures with meniscal damage followed by a discussion of the indications for proximal realignment surgery. The video discusses the case presentation of a 44-year-old woman with a history of a lateral tibial plateau fracture and meniscal loss after partial meniscectomy. Radiographs revealed a depressed lateral tibial plateau and substantial degeneration of the remainder of the lateral meniscus. Lateral hemi-tibial plateau transplantation with concurrent distal femoral varus osteotomy was performed on an outpatient basis. The patient was advanced through a standardized rehabilitation protocol. At 4 months postoperatively, the patient had substantially improved pain and functional range of motion and was able to perform most activities of daily living without considerable limitations. Hemi-tibial plateau allograft transplantation with concurrent distal femoral varus osteotomy is a reliable treatment option for patients who have a chronic tibial plateau fracture with meniscal loss. Although the literature is limited, the short- and long-term outcomes of the procedure generally are favorable; however, results are contingent on careful and consistent technique and appropriate indications.