An arthroscopic technique for the use of mosaicplasty osteochondral grafting in the treatment of femoral condylar articular defects is described. During the procedure, small cylindrical grafts are harvested from the nonweightbearing periphery of the patellofemoral joint and implanted in mosaiclike fashion into the focal cartilage defect of the weightbearing condylar surface. This report describes the arthroscopic technique using newly designed instruments and the early results of 44 patients treated by this method. Good to excellent results have been obtained based on follow-up ranging from 1 to 5 years. The modified HSS scores are compared with a control group consisting of patients treated by abrasion arthroplasty. Evaluation was done clinically and, in some cases, by ultrasound, magnetic resonance imaging, 3-dimensional computed tomography. The results of 10 control arthroscopies and the histological evaluations of 6 biopsies demonstrated the hyalinelike cartilage surface at the recipient area and the fibrocartilage formation at the surface of the donor holes.