Long-Term Outcomes of Autologous Osteochondral Transfer of the Knee Are Successful and Predicated Upon Appropriate Patient Selection.

Cartilage restoration techniques continue to grow in complexity, expanding from traditional marrow-stimulation or isolated chondroplasty of chondral lesions to various grafting procedures. Microfracture can induce a less favorable biologic response that includes formation of type I fibrocartilage and development of subchondral cystic changes or sclerosis. Thus, chondral graft options that restore native type II hyaline cartilage are favored. Autologous osteochondral transfer (AOT) is a favorable graft option because it provides native type II hyaline cartilage on an autologous subchondral scaffold that most-closely emulates the native chondral environment, and clinical studies demonstrate better functional outcomes and RTS compared to other cartilage grafting and bone-marrow stimulation procedures. Patient factors, including gender, age, lesion location, lesion size, etiology, and pre-injury function must be considered on a case-by-case basis before determining the best procedure for a given patient. In athletes, long-term functional outcomes, return-to-sport, and avoidance of arthroplasty are favorable in appropriately selected individuals. Patient selection is paramount. Commentary.