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Techniques to treat full-thickness chondral defects include abrasion, drilling, autografts, allografts, and cell transplantation. The “microfracture” technique was developed to enhance chondral resurfacing by providing a suitable environment for new tissue formation and taking advantage of the body's own healing potential. Specially designed awls are used to make multiple perforations, or “microfractures,” into the subchondral bone plate. Perforations are made as close together as possible, but not so close that one breaks into another, approximately three to four millimeters apart. Integrity of the subchondral bone plate must be maintained. The released marrow elements (including mesenchymal stem cells, growth factors, and other healing proteins) form a “super clot” which provides an enriched environment for new tissue formation. The rehabilitation program is crucial to optimize the results of the surgery. It promotes the ideal physical environment for the mesenchymal stem cells to differentiate into articular cartilage-like cells, leading to development of a durable repair cartilage that fills the original defect.