Tendon and Ligament Genetics: How Do They Contribute to Disease and Injury? A Narrative Review

A significant proportion of patients requiring musculoskeletal management present with
tendon and ligament pathology. Our understanding of the intrinsic and extrinsic mechanisms that
lead to such disabilities is increasing. However, the complexity underpinning these interactive
multifactorial elements is still not fully characterised. Evidence highlighting the genetic components,
either reducing or increasing susceptibility to injury, is increasing. This review examines the present
understanding of the role genetic variations contribute to tendon and ligament injury risk. It examines
the different elements of tendon and ligament structure and considers our knowledge of genetic
influence on form, function, ability to withstand load, and undertake repair or regeneration. The role
of epigenetic factors in modifying gene expression in these structures is also explored. It considers
the challenges to interpreting present knowledge, the requirements, and likely pathways for future
research, and whether such information has reached the point of clinical utility.