Tibial plateu "Kissing Lesion" from a proud osteochondral autograft

Knee osteochondral lesions can be debilitating. Multiple procedures have been used to manage these defects. Osteochondral autograft transplantation is one such option. Reported complications include donor-site morbidity, failed osteointegration, size mismatch, and incongruency. In this article, we report a case of graft incongruency of the medial femoral condyle that resulted in a full-thickness "kissing lesion" groove on the opposing medial tibial plateau. In an osteochondral autograft transplantation procedure, proper surgical technique is paramount to prevent placement of a proud autograft and avoid the difficult complication of associated tibial chondral defects.