Biologic and Tissue Engineering Strategies for Tendon Repair

Abstract

This review summarizes recent developments in biologic treatments-including growth factors, platelet-rich plasma (PRP), stem cells, and cell-seeded scaffolds-for tendon repair. Growth and differentiation faction-5 (GDF-5), insulin-related growth factor-1 (IGF-1), and basic fibroblast growth factor (bFGF) all improved extracellular matrix (ECM) production and tensile strength of treated tendons; however, no clinical trials were done on GDF-5. Platelet-derived growth factor-BB (PDGF-BB) improved proliferation and ECM production, but did not consistently improve mechanical properties. The literature was mixed on the efficacy of PRP for the treatment of chronic and acute tendinopathies. However, PRP did cause any complications, and its benefits may be enhanced once an ideal, standardized composition is developed. Therefore, PRP may be a valid treatment, especially once nonsurgical management options have failed. Mesenchymal stem cells (MSCs) significantly and substantially improved the quality of tendon repairs and demonstrated the ability to regenerate an enthesis. Adipose-derived stem cells (ADSCs) have similar effects and are easier to harvest. The periosteum may also regenerate the tendon-bone attachment. Tenocytes, meanwhile, may be ideal for midsubstance tendon repairs. Cell-seeded scaffolds-especially ECMderived scaffolds-were demonstrated to improve ECM production, enhancing the healing abilities of tenocytes or stem cells while providing early mechanical support to healing tendons.Each of these treatments demonstrated enhanced healing compared to common surgical techniques; moreover, patient outcomes may be enhanced by combining these treatments. Lay SummaryTendon injuries are very prevalent and can be debilitating. Tendon heals poorly, and the scar tissue that forms is weak and susceptible to reinjury. A major focus of orthopedic research is regenerative medicine, encouraging the formation of healthy tendon rather than mechanically inferior scar tissue. This review summarizes the recent scientific literature on biologic treatments for tendon repair, such as growth factors, platelet-rich plasma, and stem cells. The purpose of which is to show which treatments are promising candidates for clinical use and research, helping to guide physicians and to lay out a path for future research.

Modular endoprosthetic replacement for proximal tibia tumor patients

“…We proved expediency of using polyethylene terephthalate for fixation of soft tissues, as only this material use allows preserving anatomical structures as much as possible. In addition, in case of extensor apparatus fixation of the knee joint, only in polyethylene terephthalate use, tendon-like tissue is formed in the area of knee ligament attachment [3,11,13,[17][18][19][20].…”

“…These include infections, structural disorders, aseptic instability, local recurrence, and a number of soft tissue lesions [3,8,11,[17][18][19][20][21][22][23][24][25][26]. To further standardize complications, E. R. Henderson et al [8] proposed a classification that was adopted in 2014 by the International Society of Limb Salvage (ISOLS).…”

Regenerative Engineering of the Rotator Cuff of the Shoulder

“…The effects of mitogenic GFs such as fibroblast growth factor, bFGF, platelet-derived growth factor (PDGF-BB), and differentiation factors such as insulin-like growth factor-1 (IGF-1), growth and differentiation factor-5 (GDF-5), and bone morphogenetic protein-12 (BMP-12) on BMSCs are well known and have been extensively studied. ,, Recently, insulin, which closely resembles IGF-1 was reported as a molecule of interest for differentiating BMSCs into tendon. After identifying optimal dosages of insulin (10 –10 mol/L), via real time polymerase chain reaction (RT-PCR), Western blotting, and immunocytochemical analyses, the authors demonstrated the significant up-regulation of the tendon-related proteins/genes collagen type-I (COL1A1), collagen type-III (COL3A1), scleraxis (Scx), TN-C, decorin, similar to those levels observed in IGF-1, bFGF and GDF-5 administration, demonstrating the potential of insulin in rotator cuff generation (Figure C–G) .…”

Polymer-Based Constructs for Flexor Tendon Repair: A Review

“…The scar tissue is inferior in mechanical properties due to the predominant presence of type III collagen, whereas healthy tendon tissue mainly consists of type I collagen. An excessive amount of type III collagen results in loosely organized fibrils [ 13 ]. These complications can be avoided by inducing a healing response that is faster than the rate of adhesion and scar tissue formation [ 14 ].…”