Osteoarthritis (OA) is one of the most common musculoskeletal diseases, caused by cellular inflammatory responses and subsequent structural disruption in osteochondral extracellular matrix (ECM) in cartilage tissues. Various cell-therapies have been recently developed via the exogenous administration of mesenchymal stem cells (MSCs) due to their intrinsic regenerative capacity of self-renewal and chondrogenic differentiation. However, MSC-based cellular approaches have exhibited some technical limitations including dedifferentiation during MSC expansion, reduction of regenerative efficacy upon administration, and inconsistent quality control in large-scale cell production. To overcome these disadvantages, exosome mediated cartilage tissue regeneration has been investigated. Since exosome derived from MSC (MSC-exosome) transport and deliver multiple cellular components from their original MSC sources, they could be utilized as alternative therapeutic agents for OA treatment. Recent studies have shown that the administration of MSC-exosome effectively reduced a production of inflammatory cytokines in chondrocytes, increased the expression of cartilage ECM component, and eventually augment cartilage tissue regeneration in a series of in vivo studies. Therefore, this review emphasizes current engineering approaches via MSC-exosome for cartilage tissue repair, as a functional OA treatment technique.