Treatment of large articular cartilage defects is technically demanding, and healing is a complicated process often associated with failure. The aim of treatment of articular cartilage injuries is to induce an acceptable healing process. Invasive and noninvasive treatments usually have good short- to mid-term outcomes; however, long-term results have been disappointing probably due to scar formation. Thus, current options are more palliative than curative. Tissue engineering and regenerative medicine (TERM) that includes scaffolds, healing factors, stem cells, and genetic engineering was introduced to orthopaedic research in the last 2 decades. Although TERM has demonstrated utility, the expected goals are not necessarily realistic. Despite advancements, several problems still exist and must be solved. This review discusses articular cartilage structure and function, injury types, the healing process, and factors that influence the healing response. Current treatment modalities, including TERM-based strategies, and their limitations are reviewed to provide future directions for treatment.