Very small areas of damage that aren’t causing many symptoms can be managed with over the counter pain killers and exercises under the guidance of a physiotherapist. Impact activities should be avoided. Weight loss can be helpful. Unfortunately, larger symptomatic defects often require surgery. The options are dictated by the size and location of the injury: smaller areas are treated by techniques such as microfracture or osteochondral plug transfer; larger areas are treated by techniques such as autologous chondrocyte implantation or stem cell therapy. An alternative is to use a small metallic or polymer implant to resurface the defect. Whichever treatment is chosen, it is very important to assess and address underlying knee problems such as abnormal leg alignment, ligament instability or significant loss of meniscal tissue. These issues could increase the chance of failure of treatment and could have contributed to the cartilage injury in the first place.