Leptospirosis is been considered an important infectious disease that affects humans and animals worldwide. This review summarizes our current knowledge of bacterial attachment to extracellular matrix (ECM) components and discusses the possible role of these interactions for leptospiral pathogenesis. Leptospiral proteins show different binding specificity for ECM molecules: some are exclusive laminin-binding proteins (Lsa24/LfhA/LenA, Lsa27), while others have broader spectrum binding profiles (LigB, Lsa21, LipL53). These proteins may play a primary role in the colonization of host tissues. Moreover, there are multifunctional proteins that exhibit binding activities toward a number of target proteins including plasminogen/plasmin and regulators of the complement system, and as such, might also act in bacterial dissemination and immune evasion processes. Many ECM-interacting proteins are recognized by human leptospirosis serum samples indicating their expression during infection. This compilation of data should enhance our understanding of the molecular mechanisms of leptospiral pathogenesis.