Tendinopathies are frequent and represent a clinical challenge for orthopedic surgeons, mainly because they frequently do not heal spontaneously and take a long time to recover. Treatment options for tendon injuries include exercise and loading programs, therapeutic methods, and surgical procedures. However, their effectiveness in the long-term period remains unclear, and, frequently, the repaired tendons do not fully regain their strength and function. Accordingly, current therapeutic approaches concentrate on managing pain, which is frequently palliative, transient, and results in impaired function. Modern biologic strategies of tendon injuries aim to address the underlying mechanisms of the disease and enhance spontaneous tendon healing. Although many of these techniques are in their infancy, promising results have been shown in in vivo and in vitro studies. These approaches are based on the local administration of growth factors, stem cells, and gene delivery directly into the injury site mimicking physiologic tendon healing processes. Scaffolds also provide mechanical support to tendons. Significant concerns about these new techniques regard identification of targets, tissue and host heterogeneity, costs, safety issues, the choice of one system over another, and the use of biologic factors alone or in combination therapy. Hence, in this chapter, after introducing the basic biology of tendon tissue and the clinical knowledge of tendinopathy, we provide an update on the latest repair proposals for tendon tears.