 Thanks to advances in graft technology, osteocondrial lesions of the knee can be treated using transplants from healthy donors, but several challenges still remain. Matching the surface structure of a graft recipient is typically achievable when lesions are small. But for large lesions, individual differences in anatomy require that donor grafts be more carefully screened to find a match. Grafts can be especially difficult for those experiencing lesions in the medial femoral condyle. Lesions in that area are up to six times more common than those in the lateral condyle. That translates to high demand and low availability of donor grafts of this type. A new study, however, suggests that an untapped source for grafts for medial condyle defects could be found in lateral condyles of the opposite knees of donors. As one would expect, the medial and lateral femoral condyles vary in many ways, including in shape, curvature, size, and thickness. But studies are showing that, in several other ways, the lateral femoral condyle is a suitable graft source for lesions in its medial counterpart. For example, the articular cartilage of the lateral condyle is, for the most part, as thick or thicker than that of the medial condyle. And because the lateral condyle tends to be wider, it can provide the coverage needed for lesions larger than 25 mm in width. In addition, the superficial cartilage of the lateral condyle is found to be stronger in certain areas. To explore how well these grafts can match the native surface of defective knees with large cartilage lesions, researchers examined 120 fresh frozen human femoral condyles. The condyles were divided into 30 groups of four. In each group, one medial femoral condyle served as the graft recipient, while the other three were used as the donors. A single oblong graft was harvested from both a medial femoral condyle from a knee of the same side and a lateral femoral condyle from a knee of the opposite side. Finally, a third medial or lateral condyle was used to harvest two circular grafts. These two circular grafts were placed in overlapping fashion, as commonly done to treat these large lesions. Nano-CT scans revealed that the single oblong grafts obtained from medial or lateral condyles match the recipient surfaces to similar degrees. The overlapping circle grafts, however, showed significantly greater deviations. These trends were reflected in two types of surface measurements. Surface height deviation, which measured the difference between the surface of native cartilage and graft cartilage, and step height deviation, which measured the difference in height at the graft edge. The findings suggest that a single large oblong graft from either the lateral femoral condyle of the opposite side or a medial femoral condyle from the same side are both acceptable for treating medial defects, which is clinically meaningful. Given that lateral grafts are more abundant, tapping this source could help patients in need find a quicker match and receive care sooner, and could lead to lower waste of valuable donor tissue.