The treatment of patellofemoral joint cartilage defects/osteoarthritis of the knee offers a range of treatment options. With help of an algorithm, decision-making for the most suitable treatment approach is supported. Correction of malalignment and attention to patellar instability is key for successful treatment. Furthermore, the defect size, influencing factors such as "age" and prior treatments play an important role in choosing the most appropriate operative treatment option. In addition to the typical cartilage repair procedures, mini implants are used to treat localized damage. In the case of advanced osteoarthritis, there is the option of isolated patellofemoral replacement with an inlay or onlay prosthesis.