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No standard exists for matching the cartilage thickness of the donor and recipient. The goal of this study was to use finite element (FE)\u00a0analysis to identify the effect of cartilage thickness mismatches between donor and recipient cartilage on cartilage stresses in patellar transplants. Two types of FE models were used: patient\u2010specific 3D models and simplified 2D models. 3D models highlighted which geometric features produced high\u2010stress regions in the patellar cartilage and provided ranges for the parameter sweeps that were conducted with 2D models. 2D models revealed that larger thickness mismatches, thicker recipient cartilage, and a donor\u2010to\u2010recipient cartilage thickness ratio (DRCR)\u2009&lt;\u20091 led to higher stresses at the interface between the donor and recipient cartilage. A surface angle between the donor\u2010recipient cartilage interface and cartilage surface normal near the graft boundary increased stresses when DRCR\u2009&gt;\u20091, with the largest increase\u00a0observed for an angle of 15\u00b0. A surface angle decreased stresses when DRCR\u2009&lt;\u20091. Clinical Significance: This study highlights a potential mechanism to explain the high rates of failure of patellar OCAs. Additionally, the relationship between geometric features and stresses explored in this study led to a hypothetical scoring system that indicates which transplanted patellar grafts may have a higher risk of failure.<\/jats:p>","DOI":"10.1002\/jor.25569","type":"journal-article","created":{"date-parts":[[2023,4,9]],"date-time":"2023-04-09T06:28:33Z","timestamp":1681021713000},"page":"2372-2383","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Cartilage thickness mismatches in patellar osteochondral allograft transplants affect local cartilage stresses"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7942-5866","authenticated-orcid":false,"given":"Ryan","family":"Rosario","sequence":"first","affiliation":[{"name":"Department of Mechanical Engineering University of Michigan Ann Arbor Michigan USA"},{"name":"Department of Mechanical Engineering Lafayette College Easton Pennsylvania 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