As professional and recreational athletes increasingly extend their participation in sports, the prevalence of cartilage injuries, both acute and chronic, rises substantially. This article addresses the evolving landscape of care for aging athletes with knee cartilage injuries. A comprehensive diagnostic process, including a detailed patient history, thorough physical exam, and appropriate imaging, provides the foundation for effective and personalized treatment. Non-operative strategies, such as tailored physical therapy regimens and intraarticular injections, may play a pivotal role in preserving joint function, providing symptomatic relief, and delaying the need for surgical intervention. For cases necessitating operative intervention, an array of options, including debridement to stable borders, surface restoration procedures, osteochondral replacement procedures, and procedures addressing mechanical alignment, are available, and often performed in combination. In navigating the complexities of treating knee cartilage injuries in aging athletes, a commitment to refining current approaches and adapting to emerging evidence is crucial to achieving optimal outcomes and enhancing the longevity of joint health in this distinct population.