PL-Exos protect TSPCs from ferroptosis and senescence by activatingthe AMPK/Nrf2/GPX4 pathway, reducing lipid peroxidation, and preservingproliferation. In rat rotator cuff tear model, PL-Exos enhance tendon-bonehealing and improve mechanical strength in vivo, highlighting theirtherapeutic potential for tendon degeneration. This evidence concerns the gene GPX4 and rotator cuff syndrome.