The repair and reconstruction of tissue damage and degenerative diseases pose significant clinical challenges. Traditional biomaterials provide only static support and fail to adapt to the dynamic pathological microenvironment of tissue repair. In contrast, stimuli-responsive biomaterials can sense endogenous biochemical signals and exogenous physical stimuli, and achieve precise spatiotemporal regulation through dynamic changes in structure and function, making them a research hotspot in regenerative medicine. This article systematically elaborates the core mechanisms of stimuli-responsive biomaterials in tissue repair and regeneration, including dynamic mechanical support, controlled release of bioactive molecules, regulation of cellular behaviors, and remodeling of the inflammation-immunity-angiogenesis microenvironment. According to the types of triggering signals, the design principles and recent advances of materials responsive to pH, temperature, light, ultrasound, magnetic fields, and multiple stimuli are discussed. It also summarizes their application status in bone tissue repair, soft tissue repair, and targeted tumor therapy. Furthermore, it analyzes key issues in clinical translation, such as response specificity, biosafety, and large-scale preparation, and discusses future development directions, including interdisciplinary integration and intelligent closed-loop regulation. Stimuli-responsive biomaterials provide new strategies for precise and personalized tissue repair and regeneration, with significant basic research value and clinical translation potential.