Hangody et al. in 1997 were the first to report 152 cases of total cartilage defects of the knee treated with autologous osteochondral grafts, mainly using the Mosaicplasty technique, with satisfactory clinical results. In this technique, a certain number and size of columnar osteochondral blocks are obtained from the non-weight-bearing area of the knee joint as the donor area and implanted into the cartilage total defect area. Autologous osteochondral grafts are suitable for small cartilage defects (1-2 cm), athletes with relatively high replication requirements, and cartilage defects with associated bone loss because of the possibility of obtaining a hyaline cartilage-based repair result and faster healing, but because they are limited by the source of donor zone material. In addition, it can be used for revision surgery in patients who have failed microfracture treatment. The main disadvantage of this technique is that it is likely to cause complications in the donor area. The main technical points are: (1) The cartilage is usually explored arthroscopically, a small auxiliary incision is made to ensure both the smooth passage of the retrieval sleeve and the perpendicularity of the retrieval sleeve to the articular surfaces of the donor and recipient areas, and a cylindrical measuring rod is used to determine the number and diameter of grafts required. The most appropriate size retrieval sleeve is then selected to obtain a 10-15 mm long columnar osteochondral block perpendicular to the articular surface of the donor area. (2) The available sites are all non-weight-bearing areas of the knee, such as the medial and lateral talar crests and intercondylar fossa. (3) A cylindrical osteochondral hole is created in the recipient area with another, slightly smaller diameter, retriever that matches the length, diameter, and angle of the columnar osteochondral block. (4) The columnar osteochondral block is implanted into the hole until only the end is visible, and then the graft is gently tapped with the inserter until its surface is flush with or slightly below the surrounding articular surface, but not more than 2 mm, otherwise the healing of the grafted cartilage is not facilitated. (5) Do not apply excessive force to avoid chondrocyte death. (6) If more than one osteochondral block is to be grafted, repeat the procedure until the cartilage defect is filled. Only if close contact between the graft and the cancellous bone of the recipient bone bed is ensured can healing of the graft and the recipient area be facilitated; otherwise, resorption and necrosis of the graft will result. (7) The donor area can either be left open or filled with synthetic material, the latter of which can significantly reduce the incidence of postoperative hematoma. The patient is lightly weight-bearing for 4 weeks (small injury, 1-2 columnar osteochondral grafts) to 8 weeks (large injury) postoperatively. CPM machine exercises are not mandatory. If postoperative stiffness is a concern, 2-3 weeks of CPM machine exercises may be performed. Once quadriceps muscle strength and proprioception are restored, sports can be performed, which usually takes 4-6 months.