Osteochondritis dissecans remains a challenge for the treating orthopedic surgeon, both diagnostically and therapeutically. No single technique is considered the preferred treatment, given the variety of lesion types, and demographic factors that influence prognosis. Recent treatment developments that employ biomaterials and cell-based therapy have demonstrated encouraging medium-term results although there is need for longer term clinical outcome data analysis. As a method to provide long-term durability of osteochondral repair in large OCD lesions, single-stage procedures using cell-based methods with biologic augmentation and tissue-engineered scaffolding have great potential and are an exciting advancement in the field of biologic joint preservation.