title: The effect of angled osteochondral grafting on contact pressure: a biomechanical study.
abstract: BACKGROUND
  Flush osteochondral plugs can reduce contact pressure compared with an empty defect in the articular cartilage. However, incongruities such as graft angulation have an unknown effect.
  
  
  OBJECTIVE
  Incongruity of the articular cartilage after osteochondral transplantation affects articular surface contact pressure.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  An 80-N load was applied with a material testing system for 120 seconds to the femoral condyles of 50 fresh swine knees. Contact pressures were measured using Prescale super low film. Five conditions were tested: (1) intact articular surface; (2) surface with 4.5-mm-diameter circular defect; (3) defect grafted with a flush 4.5-mm-diameter plug from the contralateral condyle; (4) defect grafted with a 30 degrees angled 4.5-mm-diameter plug, with lower edge flush (tip elevated with respect to the adjacent surface); and (5) defect grafted with a 30 degrees plug, with tip flush to the adjacent surface (lower edge sunk). Angled grafts were obtained using a rotational bearing vise aligned with a 30 degrees fixed-angle track. The film was digitally scanned and analyzed, and standard statistical tests were performed.
  
  
  RESULTS
  Mean peak pressures of intact cartilage (8.57 kg/cm2), flush graft (9.81 kg/cm2), and sunk and angled graft (9.15 kg/cm2) were not significantly different (P < .5). The mean pressures for defects (12.01 kg/cm2) and the elevated angled graft (14.50 kg/cm2) were significantly (P < .05) higher than that of intact cartilage.
  
  
  CONCLUSIONS
  Slightly sunk grafts were still able to reduce elevated contact pressures to normal levels. However, elevated angled grafts increased contact pressure. These results suggest that it is preferable to leave an edge slightly sunk rather than elevated.
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. kohj1@hotmail.com
authors.forename: Jason Lee
authors.initials: JL
authors.lastname: Koh
authors.forename: Adam
authors.initials: A
authors.lastname: Kowalski
authors.forename: Eugene
authors.initials: E
authors.lastname: Lautenschlager
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D002358:Cartilage, Articular / Q000637:transplantation*; D007719:Knee Joint / Q000601:surgery*; D013552:Swine; D014481:United States; D016474:Weight-Bearing