Tissue engineering (TE) holds significant potential for repairing osteochondral (OC) defects caused by trauma and degenerative diseases. However, the structural and functional heterogeneity between cartilage and bone imposes distinct requirements for regenerative outcomes, while stable integration of the OC interface remains a critical clinical hurdle. Three-dimensional (3D) printing technology, leveraging advantages of personalized manufacturing and precise structural control, systematically optimizes the synergistic application of core TE elements (cells, growth factors, and scaffolds) during fabrication, offering advanced solutions for OC TE. By mimicking the biomechanics and the physiological regulatory mechanisms of native joints, 3D printing facilitates appropriate microenvironments across material, structural, and mechanical levels. Endowed with outstanding reasoning and predictive advantages, artificial intelligence (AI) has greatly advanced the development of 3D printing. In OC TE, AI exhibits promising applications throughout the 3D printing workflow, including printing process parameter regulation, ink evaluation, and scaffold design optimization. This paper systematically reviews OC TE’s general and region-specific requirements, followed by 3D printing’s innovative solutions and AI-assisted breakthroughs. Finally, we discuss the limitations and prospects of this interdisciplinary integration of 3D printing and AI in OC TE.