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Teachers’ knowledge of students’ misunderstandings is instrumental for effective teaching and student learning. However, there lacks a strong explanation of how this knowledge informs teachers’ responses to misunderstandings. We investigate 152 mathematics teachers’ knowledge of students’ misunderstandings of fractions and how different components of this knowledge impact their instructional decisions. We report how teachers characterized students’ fraction misunderstandings, the source of the misunderstandings, and the subsequent instructional response. Then we use logistic regression to understand how teachers’ instructional responses are predicted by those factors. We found that conceptually characterizing the misunderstanding and providing a mathematically grounded source of the error are associated with higher likelihood of providing an instructional response specific to the misunderstanding and aimed at building conceptual understanding.