Articular cartilage serves a vital role in maintaining joint function by minimising friction and distributing load. While the intricate ultrastructure of articular cartilage is critical for proper function, these same properties create challenges for cartilage restoration. Articular cartilage injury can lead to pain, dysfunction and decreased athletic participation in the short term, but can progress to osteoarthritis and deteriorating function in the long term. Currently, there is good evidence that cartilage restoration techniques are effective in improving knee function, but questions about durable joint surface restoration and return to high demand activity with long-term follow-up remain. Existing cartilage treatment options include marrow stimulation, osteochondral tissue transfer or transplantation, cell-free synthetic scaffolds and cell-based repair strategies. The current literature supporting these techniques is limited by heterogeneity in surgical procedures, lesion and patient characteristics, and reporting of non-standardised outcome measures. Therefore, often an individualised approach based on the patient's goals and surgeon preferences is necessary. In this state of the art review, we evaluate the current knowledge, practice, evidence, and surgical techniques for available cartilage restoration options. In addition, we discuss future strategies to manage articular cartilage injuries to enhance the biological quality of the repair tissue to improve clinical outcomes.
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