In the properly selected patient, alternative options to total knee arthroplasty exist for the surgical treatment of knee joint disease. These procedures involve reestablishing healthy cartilage (i.e., bone marrow stimulation, grafting, autologous chondrocyte implantation), mechanical axis correction (i.e., osteotomy), and/or replacing pathologic knee compartments with prosthetic devices (i.e., unicompartmental and bicompartmental knee arthroplasty). Treatment modality selection varies based on a number of factors, including but not limited to age, activity level, treatment history, and lesion size, location, severity, and etiology. Reestablishing healthy cartilage in pathologic knees is dependent on the recipient's capacity and propensity to heal and regenerate new cartilage. Therefore, this technique is typically conducted in young patients, with small- to medium-sized focal chondral or osteochondral lesions. Osteotomy, unicompartmental knee arthroplasty, and bicompartmental knee arthroplasty do not have the same restrictions and are used for patients with larger, isolated knee lesions. This article reviews indications, efficacy, and advancements of existing surgical techniques for the repair or restoration of knee lesion injuries.