Arthroscopic microfracturing was introduced in the 1990s as a treatment for focal cartilage defects. The principle of the procedure involves perforating the subchondral bone in the area of the defect after initial debridement, thereby allowing bone marrow and stem cells to enter the defect site and serve as a foundation for the regeneration process. Numerous studies have since documented the effectiveness of this technique. However, several limitations remain, particularly the poor quality of the regenerated tissue, which likely contributes to the fact that, especially in larger defects, long-term function is not maintained. Results tend to deteriorate after 2–3 years. As a result, in the 2000s, indications for microfracturing were narrowed, and the technique was recommended primarily for smaller defects. Concurrently, further advancements were made, such as modifying the perforation of the subchondral bone by using drilling instead of microfracturing instruments to enhance histological outcomes. Another significant development was the adjunctive use of biomaterials to stabilize the extruding bone marrow, which has also led to improved outcomes in clinical studies.