title: Osteochondral lesions of the talus: effect of defect size and plantarflexion angle on ankle joint stresses.
abstract: BACKGROUND
  Osteochondral lesions of the talus (OLTs) are a common cause of ankle pain and disability. Current clinical guidelines favor autogenous or allogenic osteochondral grafting procedures for lesions larger than 10 mm in diameter because of increased failure rates in these larger lesions with arthroscopic debridement, curettage, and microfracture. There are currently no biomechanical data nor level I clinical data supporting this size threshold.
  
  
  OBJECTIVE
  The purpose of this study was to determine the effect of OLT defect size on stress concentration, rim stress, and location of peak stress and whether a threshold defect size exists.
  
  
  METHODS
  Descriptive laboratory study.
  
  
  METHODS
  Progressively larger medial OLTs were created (6, 8, 10, and 12 mm) in 8 fresh-frozen cadaveric ankle joints. With a calibrated Tekscan pressure sensor in the tibiotalar joint, an axial load of 686 N was applied, and pressure was recorded in neutral and 15° of plantar flexion with each defect size. Peak stress, contact area, peak and average rim stresses, and location of peak stress were determined.
  
  
  RESULTS
  The distance between peak stress and defect rim was significantly decreased with increasing defect size for lesions of 10 mm and larger. Total tibiotalar contact area was significantly decreased with increasing defect size and with ankle plantar flexion. While peak joint stress and peak rim stress were not affected by defect size or plantar flexion, average rim stress was significantly increased by plantar flexion.
  
  
  CONCLUSIONS
  Reduction in contact area and shift in the location of peak stress with increasing defect size may contribute to articular cartilage degeneration, pain, and defect enlargement in patients with OLTs. There appears to be a threshold of 10 mm after which the distance between the rim of the defect and the peak stress decreases; however, there is no change in peak stress magnitude with increasing defect size.
  
  
  CONCLUSIONS
  The location of peak stress in the ankle joint becomes closer to the rim of the defect in OLTs at a threshold of 10 mm and greater in diameter. These data may have implications toward OLT size thresholds for surgical decision making in symptomatic lesions (ie, primary osteochondral transplantation procedure vs curettage and debridement). The ultimate goal is to determine whether there is a threshold defect size for primary osteoarticular graft techniques.
authors.affiliation: Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA. kjhunt@stanford.edu
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Hunt
authors.forename: Arthur T
authors.initials: AT
authors.lastname: Lee
authors.forename: Derek P
authors.initials: DP
authors.lastname: Lindsey
authors.forename: William
authors.initials: W
authors.lastname: Slikker
authors.forename: Loretta B
authors.initials: LB
authors.lastname: Chou
mesh_terms: D000843:Ankle Joint / Q000502:physiology*; D001696:Biomechanical Phenomena; D002102:Cadaver; D002357:Cartilage Diseases / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D016059:Range of Motion, Articular / Q000502:physiology*; D013314:Stress, Mechanical; D013628:Talus / Q000473:pathology*