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Osteochondral autograft resurfacing (mosaicplasty) is a well-established technique in the treatment of symptomatic osteochondral and osteochondritis dissecans lesions of the knee. The results obtained are generally very good, but are excellent in the treatment of osteochondritis dissecans. Adherence to selection criteria and good operative technique are essential. Basic scientific research is improving our understanding of the complex inter relationships that occur in both normal and transplanted hyaline cartilage; this, in turn, is enabling the refinement of operative technique and directing future advances in treatment augmentation.