Is Articular Width or Articular Length Superior to Age to Optimize ROC Matching in Talar Dome Osteochondral Allografts?

Objectives: Osteochondritis Dissecans (OCD) of the talus involves cartilage separation from the subchondral bone, affecting medial (53-58%) and lateral (34-42%) rims. Large lesions may necessitate osteochondral allograft transplantation, ensuring surface congruency and minimizing step-off. This study characterizes talar dome posteromedial (PM) and central lateral (CL) radius of curvature (ROC) correlations with age, Articular Width (AW), and Articular Length (AL) to optimize graft selection and matching. Methods: The study included 30 patients aged 9-18. Three reviewers independently conducted measurements of Magnetic Resonance Imaging studies using the Sectra PACS software, perpendicularly aligning axial and coronal planes with the talar dome surface. ROC for the PM and CL talus aspects were measured on the sagittal plane and AW and AL on the coronal and sagittal plane, respectively. Intra- and inter-observer reliability were assessed: ICC < 0.50: poor reliability; 0.50 < ICC < 0.75: moderate reliability; 0.75 < ICC < 0.90: good reliability, and ICC > 0.90: excellent reliability. R2 correlations were calculated for ROC with age, AW, and AL. Results: Mean sagittal cartilage ROC was 20.55 mm PM and 17.20 mm CL. Mean AW and AL were 27.84 mm and 36.25 mm, respectively. R2 values for PM ROC correlations with age, AW, and AL were 0.29, 0.18, and 0.62. R2 values for CL ROC correlations with age, AW, and AL were 0.06, 0.54, and 0.78. Intra-observer correlation coefficients were >0.85 for PM ROC, 0.64-0.90 CL ROC, >0.85 AW, and 0.69-0.95 AL. Inter-observer coefficients were >0.85 for PM ROC, 0.64-0.90 CL ROC, >0.85 AW, and 0.68-0.87 AL. Conclusions: Our results suggest that the AL shows a superior correlation to PM ROC and CL ROC of the talus compared to age. The AW demonstrated comparable and improved correlations on the PM and CL, respectively. AL may be a better candidate for optimizing graft sourcing and matching in osteochondral allograft transplantations.