_Applied_  
_sciences_  
_Article_  
**Composite Xenohybrid Bovine Bone-Derived Scaffold as Bone Substitute for the Treatment of Tibial Plateau Fractures**  
**[PERSON] 1,2, [PERSON] 3, [PERSON] 1, [PERSON] 3, [PERSON] 3 and [PERSON] 4,5,*(c)**  
1 Department of Surgical Sciences and Integrated Diagnostics, University of Genova, Largo R. Benzi 10, 16132 Genova, Italy  
2 IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132 Genova, Italy  
3 Department of Traumatology and Rehabilitation, C.T.O. Hospital-A.O.U. Citta della Salute e della Scienza, Via Zureti 29, 10126 Turin, Italy  
4 Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstrasse 13, 1200 Vienna, Austria  
5 Industrie Biomedicine Insubri SA, Via Cantonale 67, 6805 Mezzovico-Vira, Switzerland  
* Correspondence: [EMAIL_ADDRESS] check for updates  
Received: 30 April 2019; Accepted: 26 June 2019; Published: 30 June 2019  
**Featured Application: 1. Fractures of the tibial plateau are common, representing 1% of all human fractures. Conservative and surgical treatments have been described for their management. 2. Communuted or displaced fractures of the plateau can be challenging for orthopaedic surgeons, requiring often the use of bone grafts. 3. Autologous iliac bone graft (AIBG) is the clinical gold standard for bone transplantation. Still, this procedure exposes patients to some relevant risks. 4. Autologous iliac bone graft is the clinical gold standard for bone transplantation. Still, this procedure exposes patients to some relevant risks. 3. In order to overcome risks and limitation of AIBG, biomaterials are valuable bone substitutes when bone transplantation is required. 5. We treated our patients with a composite xenohybrid bovine bone-derived matrix, enriched in poly(L-lactide-co-caprolactone) (PLCL) and RGD-containing collagen fragments (obtained from gelatin). **  
**Abstract: Introduction: Tibial plateau fractures represent a common challenge for orthopaedic surgeons, sometimes representing complex cases to manage, where augmentation using bone grafts is required for stabilisation. Autologous iliac bone graft (AIBG) is the current gold standard for bone grafting. In order to overcome limitations related to the procedure, alternative strategies, like allogenic and xenogeneic bone substitutes have been investigated. Here, within the framework of an observational clinical study, we report clinical and radiological outcomes of patients treated for tibial plateau fractures with a composite xenohybrid bone graft, aiming at assessing clinical and radiological outcomes. Materials and Methods: We performed a cohort retrospective study of patients treated for tibial plateau fractures from May 2017 to January 2018. Thirty-four patients, i.e. 100% of those having received the bone graft under investigation for tibial plateaux fracture treatment, met the inclusion criteria and were enrolled in the study. Patients were assessed at 2 weeks, and then at a 1-, 3-, and 6-months, and 1-year follow-up. At each evaluation patients filled a visual analogue scale (VAS) for the level of pain during the day life activities and underwent physical exam and anteroposterior and lateral projection radiographs of the knee. At 1 year the Tegner Lysholm Scoring Scale, International Knee Document Committee 2000 (IKDC 2000), and Short Form (36) Health Survey (SF-36) were administered. Results: At 1-year, mean VAS decreased from \(6.33\pm 1.40\) to \(1\pm 0.79\) (P \(<0.0001\)); Tegner Lysholm Scoring Scale was \(89\pm 4.10\) and mean IKDC 2000 was \(78.67\pm 3.31\). No infections, neurovascular complications or adverse effects related to implants were reported during the clinical exams at follow-up. Mean ROM was 124 \(\pm\) 6\({}^{\circ}\). Radiographs did not show defects of consolidation or progressive post-surgical subsidence and demonstrated a good grade of integration of the implant. _Conclusions:_ Clinical and radiological outcomes, and scores of questionnaires, were good.