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Lesions of human articular cartilage most often are the result of pathologically unclear disease processes that eventually lead to primary or secondary osteoarthritis. The incidence of the latter may even increase because of traumatic cartilage/bone injuries during sport activities. Likewise, osteochondritis dissecans can lead to osseous and cartilaginous lesions. Adult articular cartilage has only a very limited repair capacity after acute and chronic insults, and thus, cartilage lesions do not heal naturally and often undergo progressive degeneration. Until today, the only proven and effective treatment for the resulting pain and disability of such patients is joint replacement with a prosthesis. Repair of articular cartilage defects is still an unsolved problem. Many methods, including use of synthetic resorbable or nonresorbable materials, have been tried to enhance the quality of the repair tissue, but so far, no method has achieved reliable repair of normal hyaline cartilage with normal biomechanical properties and bonding to the surrounding cartilage. After publication of the first results of chondrocyte transplantation in patients with localized cartilage lesions of the knee joints by Brittberg et al. in 1994, the interest in this technique has grown steadily, and it should be further evaluated. The following review should enable the reader to understand better the unique nature of cartilaginous lesions, to recognize the difficulties and controversies involved in old and novel experimental methods of cartilage repair, and to evaluate critically the developments of orthopedic therapies in repairing articular cartilage lesions.