Six comparative studies (5RCT, 1 cohort) were included in this meta-analysis comparing osteochondral autograft transfer (OAT) and microfracture (MFx) in the treatment of cartilage lesions of the knee. Activity level, patient-reported outcome scores, and the incidence of failure were pooled. Results demonstrated a significant difference in Tegner score in favour of OAT groups compared to MFx groups, though subgroup analysis suggested the difference may be associated with greater lesion size. The patient reported outcome scores also favoured the OAT groups compared to MFx within a 3-year follow-up, though no significant difference was observed when pooled at 5-10 years. The incidence of failure was significantly lower among OAT groups compared to MFx groups.