Editorial Commentary: 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 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 return to sport compared with other cartilage grafting and bone marrow stimulation procedures. Patient factors, including sex, age, lesion location, lesion size, etiology, and preinjury 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.