Bone marrow stimulation techniques still maintain their popularity for isolated cartilage lesions due to good to excellent short-term clinical results. Long-term deterioration in outcome and decline in functional outcomes can perhaps be explained by alteration or potential deterioration of the subchondral bone micro-architecture which is the main treatment area or further progression of osteoarthritis. Indications still differ among authors. Additional regenerative treatment methods (such as hyaluronate, platelet-rich plasma, bone marrow aspiration concentrate, and adipose tissue-derived stem cells) have not been supported with sufficient prospective comparative studies. The nanofracture technique is called a rebirth of the bone marrow stimulation technique, however the level of evidence is still low.