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Contact Pressure at Osteochondral Donor Sites in the Patellofemoral Joint

Ralph B. Garretson, III, MD^*, Leonid I. Katolik, MD, Nikhil Verma, MD, Paul R. Beck, MD, Bernard R. Bach, MD and Brian J. Cole, MD, MBA^,

From the ^* Department of Orthopedic Surgery, University of Pennsylvania Hospitals, Philadelphia, Pennsylvania, and the Department of Orthopedics, Rush University Medical Center, Chicago, Illinois

Address correspondence to Brian J. Cole, Rush University Medical Center, Midwest Orthopaedics, 1725 West Harrison Street, Suite 1063, Chicago, IL 60612.

Background: The lowest contact pressure point is presumed to be the best site to harvest an osteochondral plug and minimize morbidity.

Hypothesis: Patellofemoral contact pressures are not uniform and are lowest along the medial patellofemoral articulation.

Study Design: Controlled laboratory study.

Methods: Seven cadaveric knees were tested with an electroresistive, dynamic pressure sensor placed onto the femoral side of the patellofemoral joint. The extensor mechanism was loaded with 89.1 N and 178.2 N, and the knee was manually cycled 3 times (0°–105°) per load. Mean trochlear pressures were calculated.

Results: Mean contact pressures were greatest in the central trochlea (5.80 kgf/cm²), followed by the lateral (2.56 kgf/cm²) and medial trochlea (1.60 kgf/cm²) at 89.1 N (P < .05). At 178.2 N, pressures increased to 9.47, 5.81, and 2.75 kgf/cm², respectively (P < .05). Lateral trochlear pressures decreased moving distally from 1.25 to 0.50 kgf/cm² at 89.1 N and 4.57 to 1.29 kgf/cm² at 178.2 N.

Conclusions: Contact pressures are lowest along the medial trochlea and decrease distally along the lateral trochlea.

Clinical Relevance: Osteochondral plugs from the medial femoral trochlea may be desirable if trochlear size permits. If harvesting from the lateral femoral trochlea, consider harvesting distally near the sulcus terminalis.

Key Words: osteochondral transplantation • patellofemoral contact pressure • donor morbidity

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