80 patients with symptomatic cartilage lesion of the knee were selected for inclusion. The purpose of this study was to determine how adipose-derived stem cells (ADSCs) with fibrin glue and microfracture compared to microfracture alone, in terms of clinical and radiological outcomes, for the treatment of knee cartilage defects. The results found that the patients receiving adipose-derived stem cells with microfracture had significantly greater improvements at 27 months in KOOS pain and symptom subscores and VAS pain, lower Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scores at 24 months, had more patients with complete/hypertrophic cartilage coverage of the lesion or normal/nearly normal repair tissue signal intensity, and a significantly greater ICRS II score, when compared to patients receiving microfracture alone.