Osteochondral lesions are a frequent and important cause of pain and disability. These lesions are induced by traumatic injuries or by diseases that affect both the cartilage surface and the subchondral bone. Due to the limited cartilage ability to regenerate and self-repair, these lesions tend to gradually worsen and progress towards osteoarthritis. The clinical, social, and economic impact of the osteochondral lesions is impressive, and although therapeutic alternatives are under discussion, a consensus is not yet achieved. In the last decade, new strategies based on innovative tissue engineering approaches have been developed with promising results. However, in order for those products to reach the market and help the actual patient in an effective manner, there is still a lot of work to be done. The current state of the implications, clinical aspects, and available treatments for this pathology, as well as the ongoing preclinical and clinical trials, will be further analyzed herein.