Principles of Tendon Regeneration

Tendon-healing capacity is limited due to its hypocellularity and hypovascularity even after surgical repair. Tissue engineering plays a promising role in optimizing tendon regeneration. In this chapter, we discuss tendon macroscopic and microscopic structures, the native healing cascade, and the current advances and challenges of tendon tissue engineering. These engineering principles are split into three fundamental factors: cells, scaffolds, and growth factors. Several cell sources are described for clinical application, including various kinds of stem cells. We then explore the benefits and advantages of biological scaffolds over synthetic scaffolds. Next, we discuss several growth factors that play important roles in the tendon-healing process that have augmented tendon healing in animal models. Moreover, biophysical stimulation and drug repositioning concepts are described as possible strategies to facilitate tendon regeneration.