Treatment of chondral defects of the shoulder remains one of the most difficult challenges for orthopedic surgeons. Low-demand individuals and those who have a subacute onset of symptoms may improve with non-surgical palliative treatment or with palliative surgical treatment consisting of debridement. Patients with high functional expectations require a surgical treatment: reparative or restorative. Biological grafting can be useful for the treatment of Hill-Sacks lesions extending medially over the glenoid track whereas different techniques, including remplissage, can be used to treat lateral humeral head defects. In patients with bipolar or extensive unipolar disease, reconstructive treatments can be an effective alternative to total shoulder arthroplasty. Innovative strategies for the treatment of cartilage lesions have shown excellent promise, but they remain to be established as effective techniques in the shoulder. Additional work is needed in this emerging field of biological treatment of glenohumeral arthritis.