Chapter 9 - Biologic- and Synthetic-Based Scaffolds for Tendon Regeneration

Abstract

Despite advances in surgical techniques and graft technology, healing after tendon injuries remains a significant clinical challenge. Scaffold-based tissue engineering strategies aim at both mechanically augmenting the tendon repair and also biologically enhancing its intrinsic healing. Biologic grafts—allografts and xenografts—and synthetic scaffold devices using several synthetic and/or natural biomaterials have been used. Scaffolds have been designed as fiber-based, gel-based, or hybrid structures in an attempt to best achieve the mix of mechanical and biological properties. Novel strategies employing biomolecules, mechanical stimulation, cell- and gene-therapy have also been pursued. This chapter reviews the different types of scaffolds, biomaterials, and scaffold designs that have been used for tendon tissue engineering. While these scaffold strategies are conceptually attractive and supported by numerous basic science studies, further rigorous investigation including preclinical and randomized clinical trials are needed to critically evaluate and fully understand the role of scaffolds in tendon repair and regeneration.