Abstract

Cartilage and osteochondral lesions pose a major challenge due to the limited regenerative capacity of articular cartilage. Scaffold-based therapies have emerged as effective regenerative approaches, aiming to restore joint function and delay osteoarthritis progression. This chapter reviews the rationale, classification, and clinical application of chondral and osteochondral scaffolds, including monophasic, biphasic, and multiphasic designs. It highlights key materials, mechanisms of action, and commercially available scaffold systems, detailing surgical techniques and clinical outcomes. Consensus indications and contraindications are discussed, along with evidence supporting scaffold use in early osteoarthritis and complex cases. Future directions explore innovations such as 3D bioprinting, bioactive molecule delivery, and decellularized extracellular matrix scaffolds. Despite significant progress, challenges remain in tissue integration, mechanical strength, and long-term durability. Ongoing research is essential to enhance scaffold performance and broaden their clinical impact in cartilage repair.