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This article gives a comprehensive review of a two-step single surgical alternative that searches to preserve the patient's cartilage and joint. It addresses the knee from a 360-degree perspective; First, from the articular side, full-thickness cartilage lesions are treated with hyaluronic acid (HA) scaffold combined with bone marrow aspirate concentrate (BMC), which restores the articular cartilage with a hyaline-like tissue. Then, deep inside the subchondral bone, a minimally invasive procedure called Osteo-Core-Plasty (OCP) is conducted when it is affected. This procedure serves to restore the subchondral bone with structural bone autograft and BMAC derived signaling cells. The HA-BMC cartilage preserving technique with more than ten years of follow-up provides persistent and prothesis sparing surgical results, while OCP offers the further benefits of the new technology for deep joint bone-core treatment and regeneration with significant improvement in clinical score outcomes and magnetic resonance imaging. Given the evidence, these articular preservation techniques can be considered the new paradigm knee arthroplasty surgery as they can achieve a valuable and holistic approach to early osteoarthritis treatment.