Osteochondral defects of the tibial plateau, often resulting from trauma or degenerative changes, remain a complex challenge in orthopaedics. These lesions, common in young active patients after tibial plateau fractures, can disrupt knee biomechanics, increase stress on the cartilage, and accelerate joint wear, leading to early osteoarthritis and, eventually, the need for total knee replacement.

Optimal treatment goes beyond simply correcting alignment and stability—it aims to promote durable biological repair of the joint, preserving natural knee function. Among emerging solutions, osteochondral scaffolds have shown promising results: these biomimetic structures restore the osteochondral unit by regenerating both the underlying bone and overlying cartilage.

In particular, a multilayer collagen-hydroxyapatite scaffold has demonstrated safety and efficacy in reconstructing femoral condyles and the trochlea, with stable outcomes reported up to 10 years. However, evidence for its use in complex tibial plateau defects remains limited. Preliminary studies have shown short-term clinical improvements, but long-term results were lacking.

This study aims to fill that gap by evaluating the long-term clinical outcomes of this biomimetic scaffold in the treatment of complex tibial plateau osteochondral defects, with the goal of preserving joint health and preventing future functional decline.