The long non-coding RNAs (lncRNAs) have gained much attention due to its essential roles in molecular regulation. As one of the classic lncRNAs, H19 is strongly expressed during embryogenesis and plays a crucial biological function during development. Mesenchymal stem cells (MSCs) are an ideal cell source for tissue engineering in musculoskeletal system as they own the multi-differentiation ability towards osteogenesis, adipogenesis, tenogenesis or chondrogenesis. In recent years, many studies have been found in the field of H19 mediated cellular differentiation of MSCs. Here, we summarized the current understanding of H19 during multi-differentiation of MSCs and its application in tissue regeneration of musculoskeletal system. Particularly, its molecular regulation and biological function during the multi-differentiation were also discussed.