Articular Cartilage Repair: Current Strategies and Future Regenerative Concepts

Current strategies for articular cartilage repair are largely focused on the treatment of localized cartilage defects, aiming to relieve symptoms and delay the progression of osteoarthritis. While these approaches ranging from marrow stimulation to cell-based therapies have provided meaningful clinical benefit, they remain limited by their focal perspective on a disease that ultimately affects the entire joint. From an orthopedic surgeon’s viewpoint, this chapter explores the ongoing transition from isolated cartilage repair toward a comprehensive concept of joint restoration and preservation. The chapter reviews contemporary clinical practice in the management of focal cartilage lesions, including patient evaluation, surgical decision-making, and the role of established cartilage repair techniques. It then outlines an emerging paradigm shift in which future treatment strategies extend beyond the cartilage defect itself to address the joint as a biological and biomechanical organ. Advances in imaging, biomarker profiling, and artificial intelligence are discussed as tools for improved phenotyping, risk stratification, and personalized treatment planning. In this evolving landscape, the orthopedic surgeon’s role is expected to change from a primarily arthroscopic, symptom-oriented interventionist to a joint restoration and joint preservation specialist focused on modifying disease trajectories. By integrating biological repair, biomechanical optimization, and data-driven decision support, future cartilage repair strategies may enable earlier intervention, improved durability, and sustained joint function. This chapter aims to bridge current clinical practice with future regenerative and joint-preserving concepts, emphasizing realistic pathways toward restoring and maintaining joint mobility in patients at risk of osteoarthritis.