Objective <p>Recent advances in regenerative medicine have highlighted the pivotal role of stem cell-derived exosomes (SC-Exos) as promising acellular therapeutics for joint regeneration. These nanosized extracellular vesicles, which are secreted by mesenchymal stem cells (MSCs) and other progenitor cells, encapsulate bioactive molecules such as proteins, lipids, and nucleic acids, which can modulate inflammation, promote chondrogenesis, and enhance cartilage and bone repair. Unlike their cellular counterparts, SC-Exos offer advantages including lower immunogenicity, improved safety profiles, and easier storage and handling.</p> Methods <p>PubMed, Scopus, and ScienceDirect were searched through 2025 for preclinical and clinical studies on stem cell-derived exosomes in joint regeneration, with reference screening and independent reviewer selection by consensus.</p> Results <p>Emerging preclinical studies have demonstrated their potential in treating osteoarthritis, rheumatoid arthritis, and traumatic joint injuries by promoting matrix synthesis, reducing apoptosis, and modulating immune responses. Innovations in bioengineering, including exosome modification and targeted delivery systems, further enhance therapeutic efficacy. However, challenges such as standardization of isolation methods, optimization of dosing strategies, and long-term safety evaluations remain.</p> Conclusion <p>This review discusses the biological mechanisms underlying SC-Exo-mediated joint regeneration; recent advances in their application for cartilage, bone, and synovial tissue repair; and the integration of nanotechnology and biomaterials to increase regenerative capacity. Moreover, ongoing clinical trials, current hurdles in clinical translation, and future perspectives aimed at refining SC-Exo-based therapies for joint diseases are highlighted. Overcoming these barriers will be critical for advancing exosome-based regenerative strategies toward clinical practice and minimally invasive treatments for joint disorders.</p>