The key to any successful procedure is the proper indication, technique, postoperative management, and learning from failures. As we have learned, articular cartilage surface treatments (marrow stimulation techniques and cell therapy approaches) are sensitive to the integrity of the subchondral bone and certain defect characteristics that may influence outcomes. Optimized surgical technique and adequate postoperative rehabilitation are crucial in providing an optimal environment for chondrogenesis and/or maturation of the graft with maximized graft protection. Finally, if surface treatment fails, the decision-making on which subsequent technique to choose can be challenging due to possible alterations in the subchondral bone, or progression of the disease. This article will discuss insights into the basic premise of articular cartilage surface treatment techniques, their requirements and limits, and how to strategize after a failed surface treatment.
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