<p>Large focal cartilage or osteochondral defects of the knee joint represent a&#xa0;prearthritic condition and are very likely to lead to osteoarthritis (OA) if they are not treated early with regenerative techniques. The fundamental prerequisite for successful treatment is the identification of all accompanying pathologies that have led to the cartilage damage, such as axial deviations, ligament instabilities or meniscus tears, which must also be addressed. Various regenerative procedures are available for this purpose. Various regenerative procedures are available for the surgical treatment of cartilage defects. Long-term studies at the highest level of evidence have demonstrated that regenerative procedures achieve good long-term clinical outcome with low complication and failure rates. For large cartilage defect sizes (&gt; 2–3 cm²), matrix-associated autologous chondrocyte transplantation (MACT) shows significantly better long-term clinical outcome for both chondral and osteochondral lesions compared to other regenerative cartilage treatment procedures. The use of MACT is also recommended for patients with focal early degenerative lesions (focal early OA), if they have no degenerative joint changes beyond grade&#xa0;II according to Kellgren and Lawrence and no other exclusion criteria that cannot be treated, e.g. persistent ligament instability. For newly developed cartilage defect repair techniques, such as the autologous matrix-induced chondrogenesis (AMIC) procedure or the minced cartilage technique, high-quality clinical studies with longer follow-up periods are necessary. Thus, regenerative cartilage treatment provides realistic options even for large chondral and osteochondral defects and is therefore not only a technique on an individually based indication level.</p>