The role of tenomodulin in the tendon repair process.

Tendons and ligaments are essential connective tissues that attach muscle to bone and bone to bone, thus enabling the storage and transfer of kinetic energy under high-intensity and repetitive conditions. The incidence of tendon and ligament injuries caused by sports has shown an increasing trend over the years, as the population's participation in daily sporting activities continues to rise. Moreover, during the late gestational and postnatal stages, the tendon repair mechanism shifts from complete regeneration to a repair process that is characterized by some scar tissue formation. Current understanding of tendon recovery has shifted from initially focusing on local cell proliferation and extracellular matrix (ECM) synthesis at the injury sites to emphasizing dynamic matrix remodeling, cell heterogeneity, and the integrated regulation of multiple signaling pathways. Tenomodulin (TNMD) is a key regulator of tendon maturation, differentiation, and remodeling, and is recognized as a crucial marker for the tendon lineage. The review aims to systematically consolidate the role of TNMD in tendon repair process. A comprehensive analysis of the TNMD gene and protein structure and its function in different stages of the tendon repair process is presented. In addition, the review addresses the potential therapeutic applications of TNMD, providing both a theoretical framework and an experimental foundation for the development of translational strategies in tendon and ligament clinical practice.