Chondroitin sulfate (CS) is an omnipresent glycosaminoglycan with significant biologic roles. Chondroitin sulfate has not one structure but its polysaccharide backbone is modified to a smaller or higher degree according to the cell, tissue, species localization, and/or physiopathological stimuli. The potential of chondroitin sulfate for the therapy of osteoarthritis has been under investigation in several clinical trials, which have shown that it is safe and well tolerated. However, there are many issues still unresolved, such as the structure-modifying effects of CS in osteoarthritis, symptom-modifying efficacy in certain groups of patients, structure-activity-pharmacokinetic relationships, knowledge of mechanism of action, and better quality control of the preparations. Furthermore, ongoing basic research on its biologic role will probably show other therapeutic applications.