The osteochondral regeneration paradox: why biomimetic scaffolds are biologically superior but injectable systems dominate the clinic

, ATMP/Class III classification) and high associated costs. Conversely, the batch manufacturability and minimal invasiveness of injectable systems grant them a smoother regulatory path and broader market adoption, despite often resulting in monophasic repair with limited long-term mechanical fidelity. We conclude that the field of osteochondral regeneration is shaped by this structural asymmetry. While scaffolds represent the platforms most capable of delivering faithful structural repair, injectable systems are the primary route by which innovation reaches the patient. Future success depends on either the development of hybrid strategies that reconcile architectural control with surgical simplicity, or the evolution of regulatory frameworks to accommodate the necessary complexity for true tissue regeneration.