Table 1.

Pearls and Pitfalls of the Cookie Cutter Technique

Pearls	Pitfalls
Match cookie cutter tool to defect size and shape	Choosing a template that is a poor match to the defect and leads to inadequate or overzealous cartilage debridement
Debride cartilage to stable vertical borders and remove diseased surrounding cartilage	Failure to debride cartilage to calcified layer for subsequent MACI membrane application
Take care to gently mallet cookie cutter to the calcified cartilage layer	Excessive malleting, which can create subchondral violation using the cookie cutter
Allow the fibrin glue sufficient time to cure before testing implant stability and proceeding with arthrotomy closure	Early implant stability testing or arthrotomy closure, which may lead to implant dislodgement and failure