Optimizing mesenchymal stem cell therapy for tendon-bone healing: Multifaceted approaches and future directions

Tendon-bone healing remains a significant clinical challenge due to the high risk of re-rupture following injury. While mesenchymal stem cells (MSCs) show great potential in enhancing tendon-bone healing, their clinical application is limited by issues such as low delivery efficiency, restricted differentiation potential, and potential immunogenicity. Recently, various strategies combining MSCs with other approaches, such as preconditioning, biomaterial integration, gene modification, and exosome application, have been developed, resulting in improved therapeutic outcomes. This review explored the current methods used to optimize MSC therapy for tendon-bone healing, examining the advantages, disadvantages, and underlying mechanisms of each approach, providing a foundation for future research and clinical applications.