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A treatment gap exists for patients with lesions not suitable for arthroplasty or biologic repair or who have failed prior cartilage repair surgery. This study reports on the early clinical and functional outcomes in patients undergoing treatment with an individualised mini\u2010metal implant for an isolated focal chondral defect in the knee.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Open\u2010label, multicentre, non\u2010randomised, non\u2010comparative retrospective observational analysis of prospectively collected clinical data in a consecutive series of 80 patients undergoing knee reconstruction with the Episealer\u00ae implant. Knee injury and Osteoarthritis Outcome Score (KOOS) and VAS scores, were recorded preoperatively and at 3\u00a0months, 1 year, and 2 years postoperatively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy\u2010five patients were evaluated at a minimum 24\u00a0months following implantation. Two patients had undergone revision (2.5%), 1 declined participation, and 2 had not completed the full data requirements, leaving 75 of the 80 with complete data for analysis. All 5\u00a0KOOS domain mean scores were significantly improved at 1 and 2 years (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001\u20130.002). Mean preoperative aggregated KOOS4 of 35 (95% CI 33.5\u201337.5) improved to 57 (95% CI 54.5\u201360.2) and 59 (95% CI 55.7\u201361.6) at 12 and 24\u00a0months respectively (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). Mean VAS score improved from 63 (95% CI 56.0\u201368.1) preoperatively to 32 (95% CI 24.4\u201338.3) at 24\u00a0months. The improvement exceeded the minimal clinically important difference (MCID) and this improvement was maintained over time. Location of defect and history of previous cartilage repair did not significantly affect the outcome (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The study suggests that at 2 years, Episealer\u00ae implants are safe with a low failure rate of 2.5% and result in clinically significant improvement. Individualised mini\u2010metal implants with appropriate accurate guides for implantation appear to have a place in the management of focal femoral chondral and osteochondral defects in the knee.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>IV.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-020-06289-7","type":"journal-article","created":{"date-parts":[[2020,10,6]],"date-time":"2020-10-06T19:05:08Z","timestamp":1602011108000},"page":"2899-2910","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Patient\u2010specific metal implants for focal chondral and osteochondral lesions in the knee; excellent clinical results at 2 years"],"prefix":"10.1002","volume":"29","author":[{"given":"Johannes","family":"Holz","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> OrthoCentrum Hamburg Hansastrasse 1\u20103 20149 Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9856-8387","authenticated-orcid":false,"given":"Tim","family":"Spalding","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department Trauma and Orthopaedics University Hospital Coventry Clifford Bridge Road Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarek","family":"Boutefnouchet","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department Trauma and Orthopaedics University Hospital Coventry Clifford Bridge Road Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter","family":"Emans","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> Department of Orthopaedics Maastricht UMC+ P. Debyelaan 25 6229 HX Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Eriksson","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Department of Orthopaedics Stockholm South Hospital, Karolinska Institutet Sjukhusbacken 10 118 83 Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mats","family":"Brittberg","sequence":"additional","affiliation":[{"name":"<!--<label>5<\/label>--> Cartilage Research Unit University of Gothenburg, Region Halland Orthopaedics, Kungsbacka Hospital 434 80 Kungsbacka Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Konradsen","sequence":"additional","affiliation":[{"name":"<!--<label>6<\/label>--> Department of Orthopaedic Surgery Bispebjerg Hospital Bispebjerg Bakke 23 2400 Bispebjerg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemens","family":"K\u00f6sters","sequence":"additional","affiliation":[{"name":"<!--<label>7<\/label>--> Clinic for Orthopaedics, Trauma and Hand Surgery Maria\u2010Josef\u2010Hospital Greven Lindenstr. 29 48268 Greven Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Verdonk","sequence":"additional","affiliation":[{"name":"<!--<label>8<\/label>--> Orthoca, AZ Monica Hospitals Harmoniestraat 68 2018 Antwerp Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magnus","family":"H\u00f6gstr\u00f6m","sequence":"additional","affiliation":[{"name":"<!--<label>9<\/label>--> Sports Medicine Ume\u00e5 AB and Orthopedics, Department of Surgical and Perioperative Sciences Ume\u00e5 University 901 87 Ume\u00e5 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Lind","sequence":"additional","affiliation":[{"name":"<!--<label>10<\/label>--> Deptartment of Orthopedics Aarhus University Hospital Palle Juul Jensens Boulevard 99 8200 \u00c5rhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,6]]},"reference":[{"key":"e_1_2_8_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402\u2010011\u20101323\u20104"},{"key":"e_1_2_8_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010011\u20101757\u20109"},{"key":"e_1_2_8_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2003.09.025"},{"key":"e_1_2_8_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0749\u20108063(97)90124\u20109"},{"key":"e_1_2_8_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2007.02.007"},{"key":"e_1_2_8_7_2","unstructured":"Dansk Knaealloplastikregister(2013)Danish Knee Arthroplasty Register.Annual Report"},{"key":"e_1_2_8_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2007.07.005"},{"key":"e_1_2_8_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010014\u20102999\u20100"},{"key":"e_1_2_8_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/1947603516650002"},{"key":"e_1_2_8_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010017\u20104714\u20104"},{"key":"e_1_2_8_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10561\u2010019\u201009768\u20105"},{"key":"e_1_2_8_13_2","volume-title":"Australian Orthopaedic Association National Joint Replacement Registry. 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June 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 September 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 October 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Four authors on the paper are members of the Consultant Advisory Board for Episurf, manufacturer of the implant in the paper (TS, JH, MB, KE). There are no other conflicts.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Ethical approval was obtained in all surgical centres.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}