20 studies (1,375 patients) were included to compare activity based outcomes between microfracture, autologous chondrocyte implantation (ACI), and osteochondral autograft (OAT). The outcomes measured were Knee Injury and Osteoarthritis Outcome Score (KOOS), the Tegner Score, the Cincinnati Knee scores, the International Knee Documentation Committee (IKDC) subjective knee score, the Marx activity score, and the rate of return-to-sport. The results of the systematic review suggested better Tegner scores at 1 year and lKDC scores at 2 years with ACI over microfracture, and Marx scores at 2 years with OAT over microfracture. However, microfracture had better Lysholm scores at 1 year compared to ACI, and overall earlier return to sports. Other outcomes and overall reoperation rates were similar across all techniques, except ACI had more unplanned re-operations due to graft delamination or hypertrophy.