Osteochondral techniques: where are we now?

Hyaline articular cartilage is a unique, highly specialized tissue with a distinct architecture that lacks intrinsic means to heal effectively when injured in the adult. Symptomatic osteoarticular defects continue to be a formidable challenge for the clinical and scientific communities alike. Of the various surgical treatment options that have been proposed to this end, only osteochondral grafting techniques reliably restore appropriate hyaline tissue in acquired articular cartilage lesions, especially when these involve the subchondral bone. Both autologous and allogeneic graft sources are available to the surgeon, who must consider the unique qualities and characteristics of either approach in the treatment algorithm. Autografts and allografts alike adhere to a common methodology, relying on osseous healing of mature osteochondral constructs to transplant the adherent viable articular cartilage. The required surgical technique is straightforward and reproducible but requires precision to restore articular surface congruity, achieve reliable bony ingrowth, and, ultimately, clinical success. Scientific investigation to further validate empirical clinical practice and to improve implant quality and safety is ongoing and holds great promise for the future of osteochondral grafting in joint preservation.