From physical modalities to energy-responsive biomaterials: Current strategies and challenges in tendon-to-bone healing.

Impaired functional regeneration following tendon-to-bone interface (TBI) injury is a major challenge in sports medicine. The rigidity and limited efficacy of existing rehabilitation strategies remain significant constraints. Physical modalities, leveraging advantages such as non-invasiveness, spatiotemporal controllability, and low immunogenicity, offer effective intervention options for the long-term management of TBI healing. However, conventional physical modalities struggle to address the complex pathological microenvironment involved in TBI healing. In contrast, therapeutic strategies utilizing physical energy-responsive biomaterials enable programmable, precise, and dynamic regulation, potentially integrating these advantages while overcoming inherent limitations, thereby opening new and effective therapeutic avenues for TBI healing. This review systematically examines the benefits, current applications, and shortcomings of physical modalities for TBI injuries, with particular focus on parameter-response relationships and underlying biological effector mechanisms. Furthermore, it summarizes the design strategies and application progress of energy-responsive biomaterials in TBI healing and discusses future directions and promising prospects, aiming to address the core therapeutic challenges in achieving robust TBI healing.