Focal articular cartilage injuries of the knee are common and can be challenging to manage. To appropriately counsel and indicate patients for treatment, having a complete understanding of a patient’s symptoms, goals for treatment, activity level, physical examination, and imaging findings is critical. Conservative measures, including activity modification, anti-inflammatory medication, physical therapy, and injections can result in substantial symptom relief. Reoperation after cartilage procedures is common and should be discussed preoperatively. Similarly, a successful outcome may be associated with incomplete pain relief or functional return. Treatment paradigms will continue to evolve as techniques improve and novel technologies are investigated.