Purpose: The purpose of this study was to estimate the effect of platelet-rich plasma (PRP) augmentation in microfractures of chondral lesions in elderly individuals. Methods: 29 patients with knee osteoarthritis were enrolled in the single-blinded randomized study. The study group consisted of 16 patients and 13 were in the control group. All surgeries were performed in the same manner. The PRP injection was made in a dry arthroscopy directly over the microfractures. The evaluation was performed preoperatively on the 6th, 12th, and 24th week following the surgery. WOMAC and Lysholm questionnaires were utilized. Results: Microfracturation showed WOMAC improvement in the PRP group (p = 0.0012) and in the control group (p = 0.0042). No statistically significant differences between the two groups (p = 0.698) have been found. Clinical improvement was noted in the first six weeks after which the effect lasted. In addition, Lysholm score showed no significant differences at the end of the follow-up between both groups (p = 0.941). Conclusions: Arthroscopic microfracture improves motor function and reduces pain in patients over 50 years old. PRP augmentation of the procedure is safe, and can accelerate and prolong the therapeutic effect of treatment. Excellent effects of the procedure are observed in the first six weeks, after which the improvement lasts.