Tissue-engineering strategies for the tendon/ligament-to-bone insertion

Lester Smith, Younan Xia, Leesa M. Galatz, Guy M. Genin, Stavros Thomopoulos

Research output: Contribution to journalReview articlepeer-review

90 Scopus citations

Abstract

Injuries to connective tissues are painful and disabling and result in costly medical expenses. These injuries often require reattachment of an unmineralized connective tissue to bone. The uninjured tendon/ligament-to-bone insertion (enthesis) is a functionally graded material that exhibits a gradual transition from soft tissue (i.e., tendon or ligament) to hard tissue (i.e., mineralized bone) through a fibrocartilaginous transition region. This transition is believed to facilitate force transmission between the two dissimilar tissues by ameliorating potentially damaging interfacial stress concentrations. The transition region is impaired or lost upon tendon/ligament injury and is not regenerated following surgical repair or natural healing, exposing the tissue to risk of reinjury. The need to regenerate a robust tendon-to-bone insertion has led a number of tissue engineering repair strategies. This review treats the tendon-to-bone insertion site as a tissue structure whose primary role is mechanical and discusses current and emerging strategies for engineering the tendon/ligament-to-bone insertion in this context. The focus lies on strategies for producing mechanical structures that can guide and subsequently sustain a graded tissue structure and the associated cell populations.

Original languageEnglish
Pages (from-to)95-105
Number of pages11
JournalConnective Tissue Research
Volume53
Issue number2
DOIs
StatePublished - Apr 2012

Keywords

  • Engineering of graded tissues
  • Enthesis
  • Fibrocartilage
  • Mechanical conditioning of engineered tissues
  • Mineralized fibrocartilage
  • Tendon-to-bone insertion site

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