Due to the acceleration of population aging and the increase of related factors, it is expected that the incidence of musculoskeletal diseases worldwide will rise. Despite the high disability rate, clinical options for treating musculoskeletal disorders are still limited. Hydrogel microspheres (HMS) are colloidal particles with nanoscale cross-linked polymer networks, which have excellent biocompatibility, easily adjustable structures (such as stiffness, porosity and composition) and high encapsulation efficiency of therapeutic drugs. For example, drugs and cells. Currently, various technologies are used for the manufacturing of HMS and the packaging of therapeutic agents. HMS can be produced and used in different states to match specific purposes. These ideal characteristics and their injectability endow HMS with multifunctionality, making it a promising tool for various biomedical applications such as delivery of biologics, tissue regeneration, and bio lubrication, thus making them a promising tool for problem-solving. Various clinical diseases. Here, the focus is on the manufacturing and application of therapeutic HMS for i) bone diseases, ii) cartilage and osteochondral diseases, iii) intervertebral disc (IVD) diseases, and iv) neurovascular diseases, with the aim of summarizing recent advances to summarize key contributions and findings, and emphasizing the limitations and opportunities in this field.