One hundred forty-six fractures of the tibial plateau were reviewed with a mean follow-up of 7.9 years. A functional score and an anatomic score were defined for each case, by analysis of the clinical and radiological data; these 2 scores were closely related (p < 0.00001). The lesions at injury (cartilage, menisci and ligaments) and the late condition (articular incongruity, axial abnormality and instability of the knee) influenced the functional score and the importance of late arthritis. An anatomical reconstruction of the fracture is essential for a good final result.