Bone tissue loss as a consequence of the natural aging process or as a result of trauma and degenerative disease has led to the need for procedures to generate cartilage and bone for a variety of orthopedic applications. The ability to transfer genes into multipotential mesenchymal stem cells, while still in its infancy, offers considerable therapeutic hope in a variety of musculoskeletal disorders. However, the choice of gene delivery method is key. This review examines the various techniques and methods currently available to enable gene transfer into a target population from viral methods (transduction) to nonviral (transfection) methods and the limitations associated with each method. The potential applications and current understanding of each method are presented. Given the demographic challenge of an aging population, the ultimate goal remains the development of simple, safe, and reproducible strategies for gene delivery that will address the pressing orthopedic clinical imperatives of many.