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Diabetes mellitus causes neuromusculoskeletal disorders characterized by abnormalities of nervous tissue, joint and bone. Early diagnosis and prevention of disease progression is difficult in cases of neuropathic arthropathy of the knee in diabetes. We report the case of a patient with type 1 diabetes mellitus who developed an insufficiency fracture of the medial part of the proximal tibia, which was viewed as an early finding of neuropathic arthropathy of the knee. In surgical treatment of the fracture, allograft bone transplantation and internal fixation were performed after curettage of the pathologically fragile lesion. Postoperatively, radiological findings have showed complete allograft bone incorporation and no evidence of degenerative changes. Recognition of an insufficiency fracture of the knee as an early indicator of neuropathic arthropathy and prompt treatment of the fracture using allograft bone transplantation could result in joint preservation. (C) 2012 Elsevier B.V. All rights reserved.