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This study tested the hypothesis that a metric of elevated contact stress exposure would predict the onset of PTOA. The ankles of 10 tibial plafond fracture patients were treated initially using a spanning fixator, with subsequent screw fixation of the articular surface. Following up on an earlier report of finite element computed post-operative contact stress distributions in these patients' ankles, Kellgren�CLawrence (KL) scores were assessed from minimum 2-year follow-up radiographs to characterize the presence/severity of PTOA. At that time point, seven patients had developed PTOA (KL?��?2). Five different metrics of contact stress exposure were calculated, all of which exhibited excellent concordance with KL scores, ranging from 88% to 95%. When time of stress exposure was included, one metric was able to predict PTOA development (KL?��?2) with 100% reliability, and all metrics exhibited >94% prediction reliability. These findings, albeit in a small population, support the existence of a contact stress exposure threshold above which incongruously reduced tibial plafond fractures are highly likely to develop PTOA. ? 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 29:33�C39, 2011 ""Variations in serum markers of collagen production (CICP) and degradation (ICTP), insulin-like growth factor I (IGF-I) and anterior knee laxity (AKL) were measured in 20 women [10 with spontaneous cycles (eumenorrheic), 10 using oral contraceptives] over 5 consecutive days at menses (M1�CM5, 1st pill week), the initial estrogen rise near ovulation (O1�CO5, 2nd pill week), the initial progesterone rise of the early luteal phase (EL1�CEL5, 3rd pill week) and post-progesterone peak of the late luteal phase (LL1�CLL5, 4th pill week). ICTP was higher in oral contraceptive women (5.3?��?1.7 vs. 3.7?��?1.3??g/L; p?=?0.030), primarily during days near ovulation and the early luteal phase when concentrations decreased in eumenorrheic women (p?=?0.04). IGF-I concentrations increased during menses then decreased and remained lower during the early and late luteal phase in oral contraceptive women, resulting in lower concentrations compared to eumenorrheic women at EL2 and LL1 (p?=?0.03). CICP decreased in early and late luteal days (p?