A significant number of patients suffer from focal articular damage that is neither appropriate for traditional arthroplasty, nor for biological repair. Since 2005, contoured focal resurfacing systems for the femoral condyle have been available that can cater for this specific subgroup of patients. Independent long-term data on these implants have previously been lacking, but are now becoming available. This review will look at: the basic biology of cartilage, the natural progression of focal cartilage disease in the knee, the surgical and non-surgical options available, the indications for focal resurfacing, surgical techniques, which implants are currently available, and the current clinical data with respect to these.