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The late Mercer Rang from the Hospital for Sick Children in Toronto always recommended that, in osteochondral fractures of the knee, the loose fragment should be removed and thrown away. His rationale was that it was impossible to recreate the perfect articular surface by attempting to replace the fragment using pins or screws, by drilling or curetting the cavity or by osteochondral grafting. Whether newer cellular techniques will succeed remains to be seen.
Fernando Fonseca and Inês Balacó  have presented 12 cases of young adults with osteochondritis dissecans treated by mosaic type osteochondral grafts. In their conclusions they acknowledge the need for prudence in expectations for the long term and the failure of the technique to influence the natural history of adult osteochondritis dissecans.
Faced with a hole, the natural instinct of the surgeon is to fill it, but, in the case of the articular surface of a joint, until this can be perfectly achieved, the instinct should be resisted lest the treatment itself inflicts additional damage to the joint.