Contact Forces Acting on Large Femoral Osteochondral Allografts During Forced Knee Extension

A single cylindrical graft plug is commonly used for large focal femoral defects during osteochondral allograft (OCA) transplantation. Excessive contact force (CF) on a proud plug could compromise initial healing. CFs during forced knee extension are of particular interest because this maneuver is used by therapists to restore early postoperative range of motion.

A proud OCA plug will significantly increase the CF and significantly decrease the knee extension angle (KEA).

Controlled laboratory study.

Eleven human knee specimens had miniature load cells installed in both femoral condyles at standardized locations representative of clinical defects. Each load cell had a 20-mm-diameter cylinder of native bone/cartilage attached at its precise anatomic location. Four spacers, 0.5 mm in thickness, were inserted sequentially between each load cell and its mounting bracket to create proud plug conditions of 0.5 to 2 mm. Measurements of the CF and KEA were recorded at extension moment levels up to 8 N·m.

At 8 N·m, the mean CFs for flush plugs were 149 ± 18 N (lateral) and 34 ± 13 N (medial). The mean increases in the medial CF (compared with flush) for 0.5-mm, 1-mm, 1.5-mm, and 2-mm proud conditions were 31 N (+91%), 64 N (+188%), 111 N (+325%), and 154 N (+451%), respectively. Corresponding increases for lateral proud plugs were 55 N (+37%), 120 N (+81%), 162 N (+109%), and 210 N (+141%), respectively. The CFs (and CF increases) for lateral grafts were significantly ( P < .05) higher than corresponding values for medial grafts at each proudness condition. Medial plug proudness had no consistent effect on the KEA. A 1-mm proud lateral plug significantly reduced the KEA by -1.6° (0 N·m) and -0.9° (2 N·m).

Graft proudness of only 0.5 mm significantly increased CFs during forced knee extension, emphasizing the surgical precision necessary to achieve normal CF levels.

It is believed that some amount of CF is beneficial in the early stages of graft healing, and our findings suggest that forced knee extension may be well suited for this purpose. However, the surgeon should be aware that large extension moments can also generate relatively high CFs, especially if the plug is proud.