Stress Distribution within the Osteochondral Lesions of the Talus with Nonshoulder-type and Shoulder-type

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Fukuoka Uiversity Faculty of Medicie, JAPAN Tomoobu Hagio, MD, PhD,

1 Stress Distributio withi the Osteochodral Lesios of the Talus with Noshoulder-type ad Shoulder-type Departmet of Orthopaedic Surgery, Fukuoka Uiversity Faculty of Medicie, JAPAN Tomoobu Hagio, MD, PhD, Ichiro Yoshimura, MD, PhD, Kazuki Kaazawa, MD, So Miokawa, MD, Takuaki Yamamoto, MD, PhD

$Itroductio Microfracture is a effective treatmet for Osteochodral lesios of the talus (OLT), particularly i$ $Recet studies reported that microfracture uderwet shoulder-type OLT who had sigificatly worse cliical outcomes$

2 Itroductio Microfracture is a effective treatmet for Osteochodral lesios of the talus (OLT), particularly i cases with smaller lesios less tha 15mm or 150 mm 2. Recet studies reported that microfracture uderwet shoulder-type OLT who had sigificatly worse cliical outcomes tha oshoulder-type OLT. To the best of our kowledge, o previous reports have provided biomechaical data for how oshoulder-type ad shoulder-type OLT affect the cliical outcomes.

3 Purpose The purpose of this study was to clarify the stress distributio i articular cartilage of the talus with oshoulder-type ad shoulder-type OLT usig fiite elemet (FE) aalysis.

Materials & Methods Case: the healthy voluteers - 33-year-old male (Case1). - 29-year-old female (Case2).

4 Materials & Methods Case: the healthy voluteers - 33-year-old male (Case1) year-old female (Case2). Three-dimesioal FE models of akle joit - CT data usig Mechaical Fider software (Versio 7.0; Research Ceter of Computatioal Mechaics, Tokyo, Japa). Articular cartilage of the tibia ad talus mm thickess. FE model

Materials & Methods Noshoulder-type (NS type) lesio ad Shoulder-type (S type) lesio models a - Cartilage defects: 5, 7, 9, 11, 13, 15 mm Loadig coditio at 686 N o the upper part of the tibia from the

5 Materials & Methods Noshoulder-type (NS type) lesio ad Shoulder-type (S type) lesio models a - Cartilage defects: 5, 7, 9, 11, 13, 15 mm Loadig coditio at 686 N o the upper part of the tibia from the tibial axis for body-weight b loadig. The peak ad average articular cartilage stress, ad defect rim stress were compared betwee the two models ad amog the six differet defect sizes. a. NS type lesio model b. S type lesio model

6 Results The peak ad average articular cartilage ad defect rim stress Lesio (mm) Articular cartilage stress (average, MPa) Defect rim stress (average, MPa) Defect rim stress (peak, MPa) NS type S type NS type S type NS type S type Case 1 Case 2 Case 1 Case 2 Case 1 Case 2 Case 1 Case 2 Case 1 Case 2 Case 1 Case

7 The NS type ad S type lesio models i Case 1, stress cocetratio was see at the cartilage defect rim. The articular cartilage ad defect rim stress icreased with icreasig defect size of the two models.

8 The NS type ad S type lesio models i Case 2, stress cocetratio was see at the cartilage defect rim. The articular cartilage ad defect rim stress icreased with icreasig defect size of the two models.

9 Discussio Lesio size of OLT was the most powerful predictor of the cliical outcome. The cotaimet of OLT has bee cosidered of secodary importace because it was thought that cotaied ad ucotaied lesios of comparable lesio size behave similarly. The shoulder-type OLT experiece a worse cliical outcome tha the oshoulder-type OLT, eve after adjustmet for OLT size ad regardless of locatio. FE models of kee demostrated that distributio of peak stress was cocetrated o the defect rim for defects of 10 mm ad greater. Although, peak rim stress did ot sigificatly icrease, as defects were elarged from 10 mm to 20 mm.

10 Coclusios The preset study evaluated the stress distributio i the articular cartilage of the talus with NS type ad S type OLT usig FE aalysis. I the cartilage defect with the diameter of 13 mm ad more, the S type lesio models exhibited higher peak defect rim stress tha the NS type lesio models.

11 Refereces [1] Zegerik M, Struijs PA, Tol JL, va Dijk CN.; Treatmet of osteochodral lesios of the talus: a systematic review. Kee Surg Sports Traumatol Arthrosc. 2010;18: [2] Chuckpaiwog B, Berkso EM, Theodore GH.; Microfracture for osteochodral lesios of the akle: outcome aalysis ad outcome predictors of 105 cases. Arthroscopy. 2008;24: [3] Choi WJ, Park KK, Kim BS, Lee JW.; Osteochodral lesio of the talus: is there a critical defect size for poor outcome? Am J Sports Med. 2009;37: [4] Choi WJ, Choi GW, Kim JS, Lee JW.; Progostic sigificace of the cotaimet ad locatio of osteochodral lesios of the talus: idepedet adverse outcomes associated with ucotaied lesios of the talar shoulder. Am J Sports Med. 2013;41: [5] Keyak JH, Rossi SA, Joes KA, Skier HB.; Predictio of femoralfracture load usig automated fiite elemet modellig. J Biomech. 1998;31:

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