Transplantation of Bone Marrow Stem Cells Stimulated by Proteins Scaffold to Heal Defects Articular Cartilage of the Knee

Inclusion Criteria: * Active patients (30 to 75 years) * A localized osteochondral defect of both condyle and/or tibia grade 4 (ICRS classification) * with cartilage on the tibial surface no more than grade 3-4, of size \< 3-4 cm2, with 3/4 of meniscus present. * Stable knee ; previous ligament reconstruction, if stable * A defect that is 1 - 4 cm2 or more, up to 6 cm2, located on the femoral condyle and /or less of 4 cm2 for tibial plate, and IKS score \<75. * Kissing lesions admitted * Ability to understand and willingness to sign consent form Exclusion Criteria: * Patients younger than 30 years and older than 75 years * Diffuse and advanced articular cartilage degeneration of the joint * Axial malalignment, meniscal pathology, and ligamentous instability are relative contraindications that have to be dealt with primarily either concomitantly or before the transplantation during 1 of the 2 stages of the procedure. Refusal of the patient to address these conditions in presence of a cartilage lesion is a criterion for exclusion from the study, to avoid the impact of these knee pathologies on the final results * Existing infection in or around the joint \& lesions of infectious or oncologic etiology. * Debilitated patients. * Immunocompromised patients. * Patients with autoimmune disorders \& systemic inflammatory disease. * Preoperative poor neurological or vascular status of the affected limb. * Specific contraindications include the use of tobacco and medications that may impair cell proliferation, such as NSAIDs and immunosuppressive drugs. Patients must be nicotine-free (stop smoking) prior to the procedure, as studies have shown that the oxidative effect of smoking impairs cell function and subsequent healing.