The article discusses the challenges and progress in cartilage regeneration, contrasting it with bone regeneration. Despite initial optimism, cartilage regeneration has proven more difficult than bone regeneration, which has seen numerous successful reparative approaches. The authors highlight the differences in the physiologic environment and cellular composition of bone and cartilage, emphasizing that bone's inherent regenerative capabilities, including stem cells and vascularity, are not present in cartilage. Cartilage's avascular nature and low metabolic activity make it less capable of mounting a functional healing response. The article reviews various clinical strategies for cartilage regeneration, such as microfracture, autologous chondrocyte implantation, and osteochondral grafts, noting their limitations. It also explores the use of scaffolds and non-scaffold approaches, such as scaffoldless neocartilage formation, to address the challenges of creating biomechanically suitable and immunologically compatible cartilage. The authors emphasize the importance of integrating engineered cartilage with native tissue and the need for further research to develop durable repair methods that prevent osteoarthritis.The article discusses the challenges and progress in cartilage regeneration, contrasting it with bone regeneration. Despite initial optimism, cartilage regeneration has proven more difficult than bone regeneration, which has seen numerous successful reparative approaches. The authors highlight the differences in the physiologic environment and cellular composition of bone and cartilage, emphasizing that bone's inherent regenerative capabilities, including stem cells and vascularity, are not present in cartilage. Cartilage's avascular nature and low metabolic activity make it less capable of mounting a functional healing response. The article reviews various clinical strategies for cartilage regeneration, such as microfracture, autologous chondrocyte implantation, and osteochondral grafts, noting their limitations. It also explores the use of scaffolds and non-scaffold approaches, such as scaffoldless neocartilage formation, to address the challenges of creating biomechanically suitable and immunologically compatible cartilage. The authors emphasize the importance of integrating engineered cartilage with native tissue and the need for further research to develop durable repair methods that prevent osteoarthritis.