Fibrous Systems as Potential Solutions for Tendon and Ligament Repair, Healing, and Regeneration

Abstract

Tendon and ligament injuries caused by trauma and degenerative diseases are frequent and affect diverse groups of the population. Such injuries reduce musculoskeletal performance, limit joint mobility, and lower people's comfort. Currently, various treatment strategies and surgical procedures are used to heal, repair, and restore the native tissue function. However, these strategies are inadequate and, in some cases, fail to re‐establish the lost functionality. Tissue engineering and regenerative medicine approaches aim to overcome these disadvantages by stimulating the regeneration and formation of neotissues. Design and fabrication of artificial scaffolds with tailored mechanical properties are crucial for restoring the mechanical function of tendons. In this review, the tendon and ligament structure, their physiology, and performance are presented. On the other hand, the requirements are focused for the development of an effective reconstruction device. The most common fiber‐based scaffolding systems are also described for tendon and ligament tissue regeneration like strand fibers, woven, knitted, braided, and braid‐twisted fibrous structures, as well as electrospun and wet‐spun constructs, discussing critically the advantages and limitations of their utilization. Finally, the potential of multilayered systems as the most effective candidates for tendon and ligaments tissue engineering is pointed out.

State-of-the-art review of advanced electrospun nanofiber yarn-based textiles for biomedical applications

“…12 A. This consists mainly of tropocollagen molecules (∼1.5 nm in diameter), fibrils (50–500 nm in diameter), fibers (10–50 μm in diameters), and fascicles (50–400 μm in diameter) [ 162 , 163 ]. It has become clear that the replication of the hierarchical fibrous architecture of native tendon tissues is of significant importance for the design of scaffolds and grafts in tendon tissue engineering.…”

Engineering Complex Anisotropic Scaffolds beyond Simply Uniaxial Alignment for Tissue Engineering

“…tendon and ligament, given its nondegradable nature that may cause inflammatory responses, synovitis, and long-term fatigue failure. [201] Thus, tissue-engineering absorbable biomaterials into the HUA scaffolds have been proposed to evade these challenges by stimulating the regeneration and repair of a tendon or ligament defect. For example, the same research group also fabricated multiscale hierarchical bioresorbable scaffolds by Nylon 6,6 replacement with PLLA.…”

“…[ 67,68 ] However, it is not considered as an optimal option for the substitution of tendon and ligament, given its nondegradable nature that may cause inflammatory responses, synovitis, and long‐term fatigue failure. [ 201 ]…”

Melt-Spun, Cross-Section Modified Polycaprolactone Fibers for Use in Tendon and Ligament Tissue Engineering

“…PCL is used as a material for tissue engineering of tendons, bone and cartilage in form of nanofibers, foams and 3D printed structures [22]. Existing strategies for tendon and ligament scaffolds are manifold, including numerous studies on nanofibrous and yarn-based structures [25][26][27][28][29][30][31][32]. Given the high mechanical demands associated with tendons and ligaments, textile structures are considered promising to replace anisotropic tissues [26,33].…”

“…Existing strategies for tendon and ligament scaffolds are manifold, including numerous studies on nanofibrous and yarn-based structures [25][26][27][28][29][30][31][32]. Given the high mechanical demands associated with tendons and ligaments, textile structures are considered promising to replace anisotropic tissues [26,33]. Textile technology offers an approach to the reproducible and scalable fabrication of high-strength, load-efficient 3D-scaffolds with adjustable and interconnected pores.…”