Objective: To summarize advances over the past 10 years in articular cartilage regeneration using stem cells and scaffolds, with emphasis on clinical efficacy, safety, biomaterial innovation, and translational readiness.
Methods: A structured narrative review was conducted using PubMed/MEDLINE, the Cochrane Library, and ClinicalTrials.gov for studies published from January 1, 2015 to October 31, 2025. Two reviewers independently screened records in two steps, with disagreements resolved by a third reviewer. Priority was given to randomized trials, cohort studies or long-term follow-up data, systematic reviews, meta-analyses, and high-quality translational reviews.
Results: Matrix-Induced Autologous Chondrocyte Implantation (MACI) has the strongest evidence for focal knee cartilage defects, with more durable functional and structural improvement than microfracture in appropriately selected patients. In knee osteoarthritis, intra-articular Mesenchymal Stem Cells (MSCs) may provide small-to-moderate improvements in pain and function with acceptable short-term safety, but important heterogeneity remains in cell source, dose, processing, and outcome measures. Exosome-based therapies are still supported mainly by preclinical and early clinical data. Composite hydrogels, zonal scaffolds, and 3D bioprinting are advancing rapidly but have not reached routine clinical use.
Conclusions: Current evidence most strongly supports MACI for focal cartilage defects; MSCs still require further standardization; exosomes, next-generation scaffolds, and 3D bioprinting remain promising translational approaches rather than routine treatments.