Articular cartilage is crucial weight-bearing tissue in the human body,and the maintenance of its biomechanical functions relies on the integrity of the structure. However, due to the lack of blood supply,it is inherently limited in its ability to self-repair after injury, which can readily lead to osteoarthritis and cartilage degenerative diseases.In recent years,adipose derived mesenchymal stem cells (ADSCs) have been widely used in regenerative medicine research due to their abundant sources and convenient isolation.Exosomes derived from these cells through paracrine signaling not only inherit the biological characteristics of the parent cells, but also exhibit low immunogenicity, favorable biobarrier permeability, and high stability, making them essential mediators of intercellular signal transduction. Research has demonstrated that the RNA, proteins, and bioactive factors carried by exosomes derived from ADSCs can regulate immune responses, promote chondrocytes cell proliferation, and enhance the metabolism and activity. Meanwhile, they can also upregulate chondrogenic gene expression and inhibit cartilage-degrading genes, thereby improving the extracellular matrix and promoting cartilage repair. As high-quality nanocarriers for drugs, the combination of exosomes with bioengineering can effectively improve the repair efficiency of damaged cartilage. This review summarizes the applications and mechanisms of ADSCs-derived exosomes in cartilage repair and associated diseases, aiming to provide insights for the standardization of exosome-based therapies and the clinical treatment of cartilage injuries.