The authors review the basic science of tendons in the hand and shoulder ligaments, the current clinical status of the shoulder and cruciate ligaments, and the latest advances in research on the healing of ligaments and tendons to bone, artificial ligaments, and gene therapy. They also cover the major type 1 collagen soft tissues that are of particular interest to upper extremity surgeons and sports medicine specialists. Comprehensive and up-to-date, Repair and Regeneration of Ligaments, Tendons, and Joint Capsule provides an authoritative survey of the biology and surgical reconstruction of connective tissues in the body, with special reference to tendons and ligaments in the shoulder and knee.
Anatomy Repair Healing and Rehabilitation. Basic Science of the Shoulder Ligaments. Frozen Shoulder. Healing of Ligament and Tendon to Bone. In addition to stratified scaffolds, there is tremendous interest in designing scaffolds with a gradient of properties—that is, with a relatively gradual and continuous transition in either composition or structural organization, resulting in a linear gradient in mechanical properties Harris et al. These novel scaffolds with either a compositional Erisken et al.
Materials and structures used in meniscus repair and regeneration: a review
They may thus address the need to recapitulate the complex transition of mechanical and chemical properties that are characteristic of tissue-to-tissue junctions. Design challenges in engineering biomimetic gradients revolve around scale—how best to recapitulate the micro- to nanoscale gradients that have been reported at the tissue-to-tissue interface.
The stratified scaffold approach may represent a simpler strategy, whereby a gradation of key compositional and functional properties is preestablished by focusing on forming specific tissue regions of interest and preintegrating them through stratified design. In addition to scaffold design, it is expected that cellular contributions will play a pivotal role in mediating the regeneration and homeostasis of the gradation of compositional and mechanical properties at the interface. For example, Ma and colleagues used cell self-assembly to form bone-ligament-bone constructs by culturing engineered bone segments to ligament monolayers.
Paxton and colleagues also reported promising results when evaluating the use of a polymer ceramic composite and RGD peptide to engineer functional ligament-to-bone attachments. The biomimetic interface tissue engineering approach described in this paper is rooted in an in-depth understanding of the inherent structure-function relationship at the tissue-to-tissue interface. The studies discussed indicate that controlling cellular response via coculture, triculture, or growth factor distribution on multiphased scaffolds is a critical emerging strategy to enable the development of local gradients on a physiologically relevant scale.
Many soft tissues connect to bone through a multitissue interface populated by multiple cell types that minimize the formation of stress concentrations while enabling load transfer between soft and hard tissues. In the event of injury or other disruption, reestablishment of tissue-to-tissue interfaces is critical for the formation of multitissue systems and the promotion of integrative tissue repair. Investigations into the mechanism of interface regeneration have revealed the role of mechanical loading as well as heterotypic cellular interactions in directing the formation, repair, and maintenance of the tissue-to-tissue interface.
Moreover, functional and integrative repair may be achieved by coupling both cell- and scaffold-based approaches. The vast potential of stratified scaffold systems is evident because 1 they are designed to support multitissue regeneration by mediating heterotypic cellular interactions and 2 they can be further refined by incorporating well-controlled compositional and growth factor gradients as well as the use of biochemical and biomechanical stimulation to encourage tissue growth and maturation.
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Interface tissue engineering will be instrumental for the ex vivo development and in vivo regeneration of integrated musculoskeletal tissue systems with biomimetic functionality. Yet there remain a number of challenges in this exciting area.
These include the need for a better understanding of the structure-function relationship at the native tissue-to-tissue interface and of the mechanisms that govern interface development and regeneration. Furthermore, the in vivo host environment and the precise effects of biological, chemical, and physical stimulation on interface regeneration must be thoroughly evaluated to enable the formation and homeostasis of the new interface. Physiologically relevant in vivo models are needed to determine the clinical potential of designed scaffolds.
The successful regeneration of tissue-to-tissue interfaces through a bioinspired approach may promote integrative and functional tissue repair and enable the clinical translation of tissue engineering technologies from bench to bedside. Moreover, by bridging distinct types of tissue, interface tissue engineering will be instrumental for the development of integrated musculoskeletal organ systems with biomimetic complexity and functionality.
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