<p>Cartilage lesions of the knee are frequent injuries in orthopedic practices. The intrinsic regenerative capacity of articular cartilage tissue is severely limited, which means that in many cases a&#xa0;surgical procedure can be indicated to restore joint function. The aim is to improve the patient’s symptoms and the functionality of the joint and to delay the progression of knee osteoarthritis. The efficacy of cartilage reconstructive procedures for tibiofemoral lesions is well established, while evidence on patellofemoral interventions is limited and controversial. The complex biomechanics and morphology of the patellofemoral joint make cartilage surgery difficult, resulting in poorer outcomes compared to the treatment of tibiofemoral joint lesions. In addition, patellofemoral cartilage reconstruction should be combined with procedures such as tibial tuberosity osteotomy and/or other realignment osteotomies when pathological deformities are present. If the abovenamed strategies fail or severe osteoarthritis develops and conservative procedures are not possible, arthroplasty can be considered. This review aims to critically illuminate the current concepts of conservative and surgical treatment of patellofemoral cartilage lesions, to present the latest clinical results and potential future perspectives in this field.</p>