The musculoskeletal system is essential for human movement. However, the increasing incidence of complex musculoskeletal injuries, which involve substantial loss of soft (muscle, skin) and hard (bone) tissues poses significant clinical challenges. Autogenous and allogeneic bone grafts are the most commonly adopted surgical methods for severe bone defects. However, severe postoperative complications, such as immune rejection and donor site necrosis, can lead to poor prognosis. Additionally, the scarcity of bone graft sources limits their application. Moreover, soft tissue injuries are often inadequately addressed in orthopedic procedures, leading to impaired muscle function and highlighting the urgent need for new strategies in integrated musculoskeletal repair. This review explores tissue engineering solutions by examining the interplay between muscle and bone physiology, elucidating their regenerative mechanisms, and evaluating innovations such as hydrogels, electrospun fibers, and conductive scaffolds for tissue repair. We advocate for integrated strategies that target the simultaneous restoration of soft and hard tissues to improve clinical outcomes.