60 patients who had grade III cartilage lesions on the medial femoral condyle were randomized to receive either mechanical debridement (MD) or bipolar radiofrequency chondroplasty (RF). 47 out of these 60 initial patients were available for 10-year follow-up. The purpose of this study was to determine the comparative efficacy of the two procedures in the long-term with regards to clinical outcomes, the rate of revision, and knee osteoarthritis (OA) progression. The findings of this study indicated greater improvement in clinical outcomes in the RF group compared to the MD group at 1, 4, and 10-year follow-up. The rate of revision was similar between groups; however, the RF group reported a significantly longer time until revision surgery was needed compared to the MD group. Progression of osteoarthritis measured via joint space narrowing demonstrated a trend favoring RF; however, there were no differences at 10-year follow-up between groups.