Tendon and Ligament Healing and Current Approaches to Tendon and Ligament Regeneration

Leong, Natalie L.; Kator, Jamie L.; Clemens, Thomas L.; James, Aaron W.; Enamoto-Iwamoto, Motomi; Jiang, Jie

doi:10.1002/jor.24475

Cited by 157 publications

(126 citation statements)

References 63 publications

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“…Ultimately, some tissues are surrounded by another loose connective tissue layer, which facilitates gliding on adjacent structures. [1,2,14,40,41] Due to their composition and highly aligned organized structure, these tissues present a nonlinear and anisotropic response to load, exhibiting high mechanical strength to withstand large tensile forces, good flexibility, and viscoelasticity, meaning a time-dependent and load history dependent behavior, exhibiting stress relaxation, creep, and hysteresis, with the possibility to resist the repeated cyclic strains typically experienced during daily activities, without damage. [2,40,[42][43][44] A typical stress-strain curve of these tissues presents an initial "toe region" (%2% strain), in which the tissue accommodates to the applied load by straightening its crimp pattern.…”

Section: Structure and Function Of Tendons And Ligamentsmentioning

confidence: 99%

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Potential of Graphene–Polymer Composites for Ligament and Tendon Repair: A Review

et al. 2020

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Tendon/ligament injuries are debilitating conditions that affect the life quality of a great percentage of the adult population. Several challenges still have to be addressed regarding the repair of these tissues, as current treatments show limited success. The use of biocompatible and biodegradable polymeric scaffolds potentially helps accomplish a complete and long‐term functional repair but, unfortunately, these materials lack adequate mechanical properties to be used in such demanding applications. Graphene is a subject of interest for tissue‐repair applications due to its electrical conductivity and mechanical properties. If incorporated adequately, it may significantly improve the physical properties of the composite, even at small loadings. Furthermore, graphene presents a biocompatible surface that may enhance cell adhesion, proliferation and differentiation and demonstrates promising outcomes in several in vitro and in vivo biological applications. Therefore, herein, the potential of graphene materials for the reinforcement of biodegradable polymers of interest for tendon/ligament repair is explored. The effect of graphene on relevant features such as mechanical properties, biodegradability, and biocompatibility is revised, to understand the feasibility of these composites to fulfill the requirements associated with these tissues and conclude how their applicability is extended to this field.

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Section: Structure and Function Of Tendons And Ligamentsmentioning

confidence: 99%

“…Healing process of tendons and ligaments. [1,2,41,43,[50][51][52] The new tissue is highly cellular and contains large amounts of water.…”

Section: Available Products For Tendon and Ligament Repair And Replacmentioning

confidence: 99%

Potential of Graphene–Polymer Composites for Ligament and Tendon Repair: A Review

et al. 2020

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“…Tendon cells, or tenocytes, are fibroblast-like in appearance and they synthesize ECM components including collagen fibers, elastin, proteoglycans [142,147]. The proportion of tendon/ligament ECM constituents can vary among individuals, mainly due to differences in the mechanical loading environment; however, they tend to have relatively consistent physiology and structure [148,149].…”

Section: Stimulating Tendon and Ligament Repairmentioning

confidence: 99%

Implementation of Endogenous and Exogenous Mesenchymal Progenitor Cells for Skeletal Tissue Regeneration and Repair

Desai

Jayasuriya

2020

Bioengineering

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Harnessing adult mesenchymal stem/progenitor cells to stimulate skeletal tissue repair is a strategy that is being actively investigated. While scientists continue to develop creative and thoughtful ways to utilize these cells for tissue repair, the vast majority of these methodologies can ultimately be categorized into two main approaches: (1) Facilitating the recruitment of endogenous host cells to the injury site; and (2) physically administering into the injury site cells themselves, exogenously, either by autologous or allogeneic implantation. The aim of this paper is to comprehensively review recent key literature on the use of these two approaches in stimulating healing and repair of different skeletal tissues. As expected, each of the two strategies have their own advantages and limitations (which we describe), especially when considering the diverse microenvironments of different skeletal tissues like bone, tendon/ligament, and cartilage/fibrocartilage. This paper also discusses stem/progenitor cells commonly used for repairing different skeletal tissues, and it lists ongoing clinical trials that have risen from the implementation of these cells and strategies. Lastly, we discuss our own thoughts on where the field is headed in the near future.

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“…malposition/ widening of bone tunnels) [14] or implant failure (dislocation/breakage, peri-implant fracture) [15,16]. Histomorphological studies of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) of the human knee joint described specific overlapping phases of healing (inflammation, proliferation, and remodeling) and found fundamental differences between intraarticular and extraarticular ligaments [17][18][19][20][21][22][23][24]. In a rabbit model, Menetrey et al described a superior healing potential of MCL tears compared to ACL tears [22].…”

Section: Introductionmentioning

confidence: 99%

The acromioclavicular ligament shows an early and dynamic healing response following acute traumatic rupture

Maier

Tuecking

Bernstein

et al. 2020

BMC Musculoskelet Disord

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Purpose: Symptomatic horizontal instability is clinically relevant following acute acromioclavicular joint dislocations. However, the intrinsic healing response is poorly understood. The present study sought to investigate timedependent healing responses of the human acromioclavicular ligament following acute traumatic rupture. Methods: Biopsies of the acromioclavicular ligament were obtained from patients undergoing surgical treatment for acute acromioclavicular joint dislocations. Specimens were stratified by time between trauma and surgery: group 1, 0-7 days (n = 5); group 2, 8-14 days (n = 6); and group 3, 15-21 days (n = 4). Time-dependent changes in cellularity, collagen (type 1 and 3) concentration, and histomorphological appearance were evaluated for the rupture and intact zone of the acromioclavicular ligament. Results: Group 1 was characterized by cellular activation and early inflammatory response. The rupture zone exhibited a significantly higher count of CD68-positive cells than the intact zone (15.2 vs 7.4; P ≤ 0.05). Consistently, synovialization of the rupture end was observed. Within the second week, the rupture zone was subject to proliferation showing more fibroblast-like cells than the intact zone (66.8 vs 43.8; P ≤ 0.05) and a peak of collagen type 3 expression (group 1: 2.2 ± 0.38, group 2: 3.2 ± 0.18, group 3: 2.8 ± 0.57; P ≤ 0.05). Signs of consolidation and early remodeling were seen in the third week. Conclusions: The acromioclavicular ligament exhibits early and dynamic healing responses following acute traumatic rupture. Our histological findings suggest that surgical treatment of acute ACJ dislocations should be performed as early as possible within a timeframe of 1 week after trauma to exploit the utmost biological healing potential. Prospective clinical studies are warranted to investigate whether early surgical treatment of ACJ dislocations translates into clinical benefits.

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Tendon and Ligament Healing and Current Approaches to Tendon and Ligament Regeneration

Cited by 157 publications

References 63 publications

Potential of Graphene–Polymer Composites for Ligament and Tendon Repair: A Review

Potential of Graphene–Polymer Composites for Ligament and Tendon Repair: A Review

Implementation of Endogenous and Exogenous Mesenchymal Progenitor Cells for Skeletal Tissue Regeneration and Repair

The acromioclavicular ligament shows an early and dynamic healing response following acute traumatic rupture

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