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Joseph N. Hall, MD (Mill Creek, WA), presents various technical pearls for using BioCartilage® extracellular matrix to treat symptomatic cartilage lesions in the 1st MTP joint, in addition to the need to address underlying conditions such as performing a Lapidus procedure as presented in this case. Dr. Hall also presents his postoperative data from a series of patients treated with BioCartilage matrix and reports greater than 90% good to excellent results.