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Due to its specific structure, articular cartilage has a limited regenerative ability. Even small lesions on the articular surface progress to an osteoarthritic deformation of the joint, with the end result the implantation of an endoprosthesis. New surgical methods for knee cartilage repair were developed at the beginning of the nineties. Mosaicoplasty and transplantation of autologous chondrocytes have been widely accepted as regular clinical procedures. Mosaicoplasty is a method in which osteochondral plugs are transferred from less load-bearing areas of the joint to a defect located on the major load-bearing surface. This technique was originally used on the knee joint, but there have also been many recent reports of its use on other joints. The major problems are cartilage availability and the patient’s age. Transplantation of autologous chondrocytes is based on arthroscopic removal of small cartilage pieces from the edge of the knee joint surface. Chondrocytes from the removed cartilage are cultivated in vitro and implanted back into the defect. Treatment of focal lesions of the femoral condyles and the patella has proved successful in young patients. Limitations include lesion size and concomitant osteoarthritic changes at the site of the defect. Both methods have yielded encouraging results for the treatment of focal chondral lesions, but the osteoarthritic type of cartilage injury remains an unsolved issue.