One hundred four patients with ICRS grade 3 or 4 articular cartilage defects of the knee (2–10 cm² in area, ≤4 cm³ in volume) were randomized to receive CCP-ACI (n=52) or MFx (n=52). The primary outcome of interest was the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Secondary outcomes of interest included complete defect repair, tissue integration, signal intensity of repair tissue, and clinical outcomes. Outcomes were assessed at 8, 24, and 48 weeks. Overall, the results of the study revealed significantly greater MOCART scores and structural cartilage repair in the CCP-ACI group at 24 and 48 weeks, although clinical improvements were comparable between groups. These findings suggest that CCP-ACI leads to better structural regeneration than MFx, with similar clinical benefits in the short term.