Injuries to the articular cartilage of the knee are common, they have a significant role in degenerative joint diseases, cartilage is unable to regenerate due to its inherent lack of vascular supply. The management of symptomatic focal traumatic articular cartilage lesions of the knee in active individuals remains a substantial challenge. Although many treatment options are currently available, none of them has fulfilled the criteria for an ideal management solution. Treatment decisions should be based on appropriate evaluation and classification of the pathology. This would enable the treating physician to choose whether to perform a repair or a restoration of the articular surface. The current article reviews the nature and types of cartilage lesions in the knee and the management options utilized in their treatment.