This review article explores the potential of engineered extracellular vesicles (EVs) in tissue repair and regeneration. EVs, which are membrane-like vesicles secreted by living cells, play crucial roles in intercellular communication and molecular transfer. Recent studies have shown that EVs from specific sources can regulate tissue repair and regeneration by delivering proteins, lipids, and nucleic acids to target cells as signaling molecules. Nanotechnology advancements have facilitated the development and exploration of engineered EVs, enhancing their therapeutic efficacy through gene editing, surface modification, and content modification. The review highlights the design logic behind engineered EVs, using typical examples to illustrate their effectiveness in various applications. It discusses the advantages and disadvantages of different engineering strategies, such as immobilizing EVs within biomaterials, P-selectin binding peptide-engineered EVs for kidney injury treatment, and exosome therapy for osteoporosis and periodontitis. The article also addresses the challenges and prospects of EVs in clinical transformation, emphasizing the need for further research to overcome these obstacles. Key points include: - EVs have been described as a cell-free tissue repair strategy. - Rational designs can improve the therapeutic potential of EVs in tissue repair. - Research advances in tissue repair with engineered EVs. - Challenges and prospects of EVs in clinical transformation of tissue engineering. The review aims to provide new insights into the design of EVs for tissue repair and regeneration applications, expanding their use in regenerative medicine.This review article explores the potential of engineered extracellular vesicles (EVs) in tissue repair and regeneration. EVs, which are membrane-like vesicles secreted by living cells, play crucial roles in intercellular communication and molecular transfer. Recent studies have shown that EVs from specific sources can regulate tissue repair and regeneration by delivering proteins, lipids, and nucleic acids to target cells as signaling molecules. Nanotechnology advancements have facilitated the development and exploration of engineered EVs, enhancing their therapeutic efficacy through gene editing, surface modification, and content modification. The review highlights the design logic behind engineered EVs, using typical examples to illustrate their effectiveness in various applications. It discusses the advantages and disadvantages of different engineering strategies, such as immobilizing EVs within biomaterials, P-selectin binding peptide-engineered EVs for kidney injury treatment, and exosome therapy for osteoporosis and periodontitis. The article also addresses the challenges and prospects of EVs in clinical transformation, emphasizing the need for further research to overcome these obstacles. Key points include: - EVs have been described as a cell-free tissue repair strategy. - Rational designs can improve the therapeutic potential of EVs in tissue repair. - Research advances in tissue repair with engineered EVs. - Challenges and prospects of EVs in clinical transformation of tissue engineering. The review aims to provide new insights into the design of EVs for tissue repair and regeneration applications, expanding their use in regenerative medicine.