Microfracture is in widespread clinical use as an intervention for symptomatic cartilage defects. While effective when used with strict indications for the treatment of smaller defects in the femoral condyles, the resultant fibrocartilaginous repair tissue has shown degradation over time when used in larger or patellofemoral defects. This article reviews the indications, technique, and results of standard microfracture. It also provides an overview of augmentation devices such as biomaterials and growth factors that have the potential to enhance the outcomes of microfracture, potentially widening its indications to include larger defects and other locations. Augmentation techniques discussed include collagen and polymer membranes, chitosan and fibrin gels, hyaluronan injections, as well as numerous growth factors.