Mesenchymal stem/stromal cell (MSC)-based therapies have shown promise for treating various injuries and degenerative diseases. However, clinical translation is limited by challenges in preserving cell viability and function from manufacturing through to delivery. MSC-derived extracellular vesicles (MSC-EVs) have emerged as a potent cell-free alternative, capable of delivering bioactive cargoes that modulate inflammation and promote tissue repair. This talk will present our work on the therapeutic potential of MSC-EVs in orthopaedic applications, including cartilage, growth plate, and bone repair, as well as degenerative joint diseases such as osteoarthritis (OA). Key findings span from early proof-of-concept studies in rats, to rabbit models combining MSC-EVs with hyaluronic acid, and large animal (pig) studies demonstrating safety and efficacy in functional joint repair. We also highlight the development of engineered MSC-EVs with enhanced yield and regenerative potency using approaches such as electromagnetic field stimulation. These engineered EVs show superior anti-inflammatory and matrix-preserving effects in chondrocyte and OA models. In parallel, we have developed EV-mimetic strategies, including cell membrane-coated nanoparticles (CNPs) which replicate key therapeutic functions of natural EVs, offering scalable alternatives for clinical translation.