Knee microfracture is a minimally invasive arthroscopic procedure designed to treat localized damage to the articular cartilage of the knee. Articular cartilage covers the ends of the bones and allows smooth, pain-free joint movement, but it has very limited ability to heal on its own due to a lack of blood supply. When cartilage damage leads to pain, swelling, locking, or instability and does not improve with conservative treatment, microfracture may be recommended, particularly for younger or active patients with small, well-defined defects. Before surgery, patients undergo clinical evaluation and imaging to confirm the size, location, and cause of the cartilage defect. Microfracture is not intended for generalized osteoarthritis but rather for focal cartilage injuries caused by trauma, degeneration, or inflammatory conditions. Patients are typically advised to plan for a prolonged rehabilitation period, as postoperative compliance is essential for success. The procedure is performed arthroscopically using small keyhole incisions. A camera is inserted into the knee to visualize the joint, and damaged cartilage along with the calcified layer beneath it is carefully removed to create stable edges around the defect. The surgeon then uses a specialized tool to create multiple small holes in the exposed bone beneath the cartilage defect. These microfractures allow blood, bone marrow, and stem cells to enter the area and form a clot over the defect. Over time, this clot matures into fibrocartilage, which fills the damaged area and helps restore a smoother joint surface. Patients usually go home the same day after surgery. Recovery focuses on protecting the fragile clot while encouraging cartilage formation. Weight-bearing is typically restricted for up to six weeks, followed by a gradual progression to partial and then full weight-bearing over several more weeks. Crutches are commonly required, and in some cases a knee brace or unloader brace may be used, depending on the location of the defect. Swelling control through ice, elevation, and rest is emphasized early, along with careful incision care. Physical therapy begins immediately and is critical to the outcome. Early rehabilitation prioritizes controlled range-of-motion exercises to stimulate cartilage growth without disrupting the clot. Strengthening exercises start early to maintain muscle support around the knee, while impact activities are delayed. Cycling without resistance may begin after the first week, followed by gradual strengthening over several months. Running, jumping, pivoting, and return to sport are introduced in stages, often between four and eight months after surgery, depending on individual progress. While complications are uncommon, risks include infection, blood clots, stiffness, residual pain, or incomplete symptom relief. When performed on appropriately selected patients and followed by strict rehabilitation, knee microfracture can significantly reduce pain, improve function, and allow a return to athletic and daily activities.