Cartilage regeneration: clinical progress and future outlook

Cartilage is susceptible to degeneration from injury, overuse, or age-related wear. Articular cartilage, the smooth hyaline cartilage covering the ends of bones in synovial joints, has limited intrinsic repair capacity because its avascular, aneural, and alymphatic matrix contains sparse, low-proliferative chondrocytes, allowing matrix damage to persist and drive joint dysfunction and osteoarthritis. Most therapies relieve symptoms without reliably restoring durable cartilage architecture. Recent advances in cell-based therapy, matrix-associated chondrocyte implantation, engineered scaffolds, controlled-release biologics, and quantitative clinical endpoints have shifted the field toward mechanism-based cartilage regeneration. In this feature review, we assess emerging clinical evidence across cell-based strategies, biomaterial- and scaffold-assisted repair, biologics, and combination approaches. We emphasize integrated, multimodal approaches and standardized outcome measures as essential for achieving durable cartilage repair and true disease modification.