Contact Pressure at Osteochondral Donor Sites in the Patellofemoral Joint

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.