<p>Cartilage-regenerative procedures are established for focal chondral defects; however, their use in osteoarthritis or inflammatory rheumatoid arthritis is the subject of current debate. Bone marrow stimulation, matrix-augmented bone marrow stimulation, autologous chondrocyte transplantation, as well as osteochondral transplantation and minced cartilage are presented, each with indications, limitations, and outcomes. Causal concomitant factors (e.g., mechanical alignment) should be simultaneously treated. For focal lesions the following applies: microfracture with early benefit but diminishing durability; matrix-augmented bone marrow stimulation with better results than bone marrow stimulation alone; autologous chondrocyte transplantation as the standard for larger defects (≥ 2 cm²) with superior long-term outcome compared with bone marrow stimulation; osteochondral transplantation for small osteochondral defects; minced cartilage with growing but still limited evidence. The S3 guideline on knee osteoarthritis and the German Society for Orthopaedic and Trauma Surgery recommendations support a&#xa0;restrained indication in osteoarthritis. In manifest knee osteoarthritis (Kellgren–Lawrence III–IV), regenerative operations are discouraged; in early osteoarthritis, a&#xa0;benefit may exist in selected patients. Inflammatory (rheumatoid) arthritis is considered a&#xa0;contraindication: the inflammatory–catabolic milieu endangers regeneration. In advanced rheumatoid arthritis with high-grade joint destruction, arthroplasty remains standard. Cartilage-regenerative therapy may be considered in individual cases when both the systemic disease and the inflammation in the joint to be treated are stably controlled and if the patient’s symptoms clearly correlate with the focal lesion.</p>