Osteosarcoma (OS) is a frequently occurring primary bone tumor, mostly affecting children, adolescents and young adults. Before 1970, surgical resection was the main treatment method for OS, but the clinical results were not promising. Subsequently, the advent of chemotherapy has improved the prognosis of patients with OS. However, there is still a high incidence of metastasis or recurrence, and chemotherapy has several side effects, thus making the 5-year survival rate markedly low. Recently, chimeric antigen receptor T (CAR-T) cell therapy represents an alternative immunotherapy approach with significant potential for hematologic malignancies. Nevertheless, the application of CAR-T cells in the treatment of OS faces numerous challenges. The present review focused on the advances in the development of CAR-T cells to improve their clinical efficacy, and discussed ways to overcome the difficulties faced by CAR T-cell therapy for OS.