Tendon and Ligament Tissue Engineering

To reproduce the biomechanical and biochemical properties similar to the native tissue structure, scaffolds for tendon and ligament treatment should have mechanical properties, biocompatibility, absence of inflammatory or immune response, and a close interaction with tendon cells [169, 170]. Nanoscaffold manufactured using electrospinning technology may provide great improvement in future practice [169]. Among biological scaffolds, the use of decellularized tendon-derived matrix increasingly represents an interesting approach to obtain medical devices for tendon substitution [168].

Stem cell therapy has been shown to a promising cell resource of tendon and ligament tissue engineering. From commonly investigated bone marrow-derived MSCs to emerging anterior cruciate ligament (ACL)-derived CD34+ stem cells, multiple stem cell types have been proven to be effective in accelerating tendon-bone healing [171]. Mechanical loading is recognized to play an important role in regulating the behaviors of cells in bone and surrounding tissues in vivo [172]. Tenocytes respond to mechanical deformation via force-sensitive membrane receptor activity, changes in cytoskeletal contractility, and transcriptional regulation [173]. Bioreactors is to provide a both an expandable source of readily available pluripotent cells and to facilitate their controlled differentiation into a clinically applicable ligament or tendon like neotissue [174]. Growth factors and small molecules are also be used in tendon and ligament tissue engineering [175].

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