30 patients with a tibial diaphyseal fracture and a residual cortical defect were randomized to receive either an autogeneous bone graft or an allograft with recombinant human bone morphogenetic protein-2 (rhBMP-2) to reconstruct the tibial defect. Surgical morbidity, clinical and radiographic signs of healing, and impact on health related quality of life (Short Musculoskeletal Function Assessment) were all measured. By the end of the 12 month follow-up period, the study showed that an allograft with rhBMP-2 is just as safe and as effective as an autogeneous bone graft for patients with tibial diaphyseal fractures and residual cortical defects.