Table 2.

Step-by-Step Fresh Patellar OWL Transplant Technique

Step	Description
1	The patient is anesthetized and positioned supine with an inflated pneumatic cuff.
2	Knee arthroscopy is performed with particular attention to the patellar cartilage and femoral trochlea status.
3	A sterile support is placed under the knee to maintain 20°-30° of flexion during the open procedure.
4	Through a 6- to 8-cm longitudinal incision in the anteromedial region of the knee and a medial parapatellar arthrotomy, the medial meniscus and Hoffa fat pad are identified and preserved.
5	It is suggested that the main surgeon be positioned on the contralateral side of the operative limb to view the everted patella’s articular surface directly.
6	Measurement of patellar thickness is performed with a caliper or with the aid of a millimeter ruler.
7	A 2.5-mm Kirschner wire is placed in the patella to achieve a joystick effect, and the patella is kept at 90° to the femoral trochlea.
8	The lesion is measured with a probe and an Arthrex transparent cannulated meter.
9	Evaluation of the plugs that will be placed in the patella is performed, with placement of the first guidewire.
10	Milling, preparation, and smoothing of the first receiving area are performed.
11	Placement of the second guidewire is performed, in addition to milling, preparation, and smoothing of the second receiving area.
12	Fixation, measurement, and preparation of the osteochondral grafts from the donor femoral condyle are performed.
13	Impaction of the first graft is performed with a press-fit technique in the most lateral bed of the recipient’s patella, flush with the surrounding cartilage; impaction of the second graft is performed in the medial bed, flush with the first graft.
14	The Kirschner wires are removed, stability is test, and the planes are closed to the skin.

OWL, osteochondral wide lesion.