This opinion paper reviews the use of expanded bone marrow mesenchymal stem cells (MSCs) in the treatment of musculoskeletal diseases, especially osteoarthritis and traumatic joint damage. This paper assesses past and present stem cell-based technologies, possible concerns about safety and efficacy, alternative or possibly parallel therapies using platelet rich plasma (PRP) and exosomes, as well as the latest concepts in modulated laser activation of stem cells. The clinical trial status and medical literature on this subject are considered, and the latest Good Manufacturing Practice (GMP) bioreactor technology is proposed as the gold standard for MSC expansion.