40 patients with focal full-thickness articular chondral defects of the knee were randomized to surgery through either mosaicplasty or microfracture. Patients were assessed over a minimum 15-years of follow-up for the Lysholm score, the rate of eventual knee arthroplasty, and if they would undergo the procedure again. Findings at 15 years demonstrated significantly better results on the Lysholm score in the mosaicplasty group compared to the microfracture group. A total of 4 patients overall required eventual knee arthroplasty, with no significant difference in rate between groups.