Bone marrow aspirate concentrate (BMAC) contains mesenchymal stem cells and cytokines that have potential regenerative effects on musculoskeletal tissues and have been used in a variety of clinical conditions. Minimal tissue manipulation obviates the need for costly tissue processing facilities and regulatory issues, and BMAC can be safely used in point of care facilities or hospitals. Bone marrow aspirate concentrate can be delivered as isolated injections or may be used as an adjunct to surgical procedures such as osteotomies, focal cartilage regeneration techniques, ligament reconstruction, and core decompression. In addition to intra-articular injections, subchondral delivery of BMAC in osteoarthritic knees with bone marrow lesions is being investigated. Short-term improvements in pain and function can be achieved with intra-articular injections in patients with mild osteoarthritis, however, disease modification has not been shown conclusively. In contrast, positive regenerative effects of BMAC have been demonstrated both in experimental and clinical studies when used as an adjunct to focal cartilage regeneration techniques or core decompression for avascular necrosis. However, the ideal cell source and concentration, delivery method, frequency, and specific indications still need to be determined. High-quality studies that have gained momentum in recent years will help determine the true value of BMAC in the treatment of musculoskeletal disease.