Osteoarthritis, a common degenerative joint disorder, has consistently increased in incidence in recent years. Bioactive scaffolds with specific surface topographies have demonstrated significant therapeutic potential for addressing the complex structures of articular cartilage and subchondral bone. Key signaling pathways, notably Wnt/β-catenin and NF-κB, are critical mediators in tissue repair processes. Developing osteochondral tissue engineering requires a thorough evaluation of parameters such as biocompatibility, biodegradability, and mechanical properties. Advanced manufacturing technologies allow precise manipulation of micro- and nano-scale topological structures, providing essential mechanical support, establishing optimal cellular microenvironments, and enabling controlled delivery of therapeutic agents and growth factors. In this review, we systematically summarized the design principles of cell scaffolds in osteochondral repair, outlined the preparation methods for topological structures, and focused on the signaling pathways related to micro- and nano-scale topological structures and how they affect key biological processes of cells, such as cell adhesion, proliferation, migration, and differentiation. Furthermore, we discussed the future development of biomaterial scaffolds with unique micro- and nano-scale topological structures to guide future treatment of osteoarthritis.