• Amit Chawla, Richard Twycross-Lewis, and Nicola Maffulli.
• Imperial College School of Medicine, Imperial College London, London, UK.
• Br. Med. Bull. 2015 Jan 1; 116: 93-103.

IntroductionChondral injuries are becoming increasingly common in the paediatric knee. First line surgical therapy is usually microfracture (MF), but the emergence of alternative techniques raises the question of what is the optimal treatment in paediatric patients.Sources Of DataA comprehensive search of PubMed, OVID, Web of Science, SportDiscus and Cochrane databases was performed using the key words 'autologous chondrocyte implantation, MF, mosaicplasty, juvenile, paediatric'.Areas Of AgreementEach technique demonstrated a significant post-surgical improvement in clinical outcome scores. However, MF demonstrated poorer outcomes in larger lesions (>3 cm(2)) and shorter durability.Area Of ControversyThe quality of the available literature is poor, and there is a lack of comparative trials.Growing PointsThe impact of defect characteristics, mechanism of injury and concomitant surgeries should be investigated.Areas Timely For Developing ResearchAppropriately powered randomized controlled trials with suitably long follow up and condition-specific outcome measures should compare different techniques against each other and placebo.© The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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