Biomaterial Scaffolds for Tendon Tissue Engineering

Tendons are musculoskeletal tissues responsible for transmitting loads between muscle and bone. Due to their frequent injury, poor native healing, and probability of refailure following surgical intervention, there is a clinical need for alternative treatments. Biomaterial-based regenerative medicine strategies offer the potential to provide a three-dimensional microenvironment design to guide native tendon healing processes toward regenerative repair of the injured tendon with minimal scar formation. Recently, a variety of tissue engineering constructs have been developed to block the contraction and scar formation mechanisms of repair and induce regeneration following injury. Such bioactive constructs are often inspired by the native composition, structure, mechanics, and biomolecule environment, offering inspiration toward the development of constructs that mimic the extracellular matrix (ECM) of tendon. In this chapter we provide an introduction to the application of tissue engineering principles toward tendon applications. We will discuss the critical structural elements of a potential active ECM analog for tendon repair. We also discuss the importance, incorporation, and assessment of biomolecular cues, cells, and mechanical stimulation for such tendon-inspired materials. We conclude by describing current and future hurdles toward clinical translation, particularly the proper design of in vivo regeneration assays.